


What I Need

by Jacqueline Albright-Beckett (xaandria)



Series: Give Me _____ [1]
Category: Supernatural
Genre: 45k+, Alternate Universe, Getting Together, M/M, Surgery, complete work, hospital au, medical AU, surgery AU
Language: English
Status: Completed
Published: 2013-12-25
Updated: 2014-01-25
Packaged: 2018-01-06 02:45:00
Rating: Explicit
Warnings: No Archive Warnings Apply
Chapters: 22
Words: 46,998
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/1101454
Author URL: https://archiveofourown.org/users/xaandria/pseuds/Jacqueline%20Albright-Beckett
Summary: <blockquote class="userstuff">
              <p>A joking phrase commonly heard between a surgeon and his tech is "Give me what I need, not what I ask for." Dr. Novak and his tech Dean will soon learn the impact this phrase has on life outside the operating room.</p>
            </blockquote>





	1. August: His Reputation Precedes Him

**Author's Note:**

  * For [tundraeternal](https://archiveofourown.org/users/tundraeternal/gifts).



>   
>  For tundraeternal. Merry Christmas.  
>  Many thanks to anoblecompanion for helping this come into existence.  
>  If you're looking for the porn, it lives in chapter 18.

**Notes for the Chapter:**

> I

Dean’s Monday began like any other: it began with the boards.

Even hospitals that had switched completely to LCD screens still called them boards, harkening back to the days when the schedule for the operating suites was painstakingly written on dry erase boards every morning. There was a great deal of information to be found on the boards; the shape of the entire day rested in the color-coded lines and columns. Dean’s eyes scanned until they found his name and room assignment.

His stomach dropped.

“Oh,” another tech, Jo, said sympathetically, shoving her ponytail underneath a scrub cap. “Have you worked with him yet?”

Dean shook his head. “But his reputation precedes him.” He turned his head to look at her. “Have you?”

“Last Monday.” Jo made a face. “His reputation does him justice.”

A glance at the clock reassured Dean that he had plenty of time before he needed to clock in. “Any tips?”

“No talking,” Jo replied. “I’m serious. No talking, no music. He doesn’t even like having a tech there. By the end of the day I was setting up my table and letting him just grab what he wanted.”

Dismayed, Dean looked at the others assigned to his room. Anesthesia was Bobby and Ellen was the circulating nurse; normally that kind of room combination would mean a day of lighthearted ribbing and laughter. “And what’s he like?”

“I don’t really know,” Jo admitted. “I didn’t really get the measure of him. He snapped a lot.” She peered around the hallway to make sure the surgeon in question was not within earshot. “He’s a bit of an asshole.”

“Like, Zachariah brand asshole or Angeles brand asshole?”

Jo shrugged. “I think we’re going to have to just call it Novak brand asshole.”

“Great.” Dean heaved a sigh as he hitched his bag higher on his shoulder. “I’m gonna need some coffee.”

II

“Oh, great.  _You’re_  the tech today?”

Grin hidden by the mask he was tying on, Dean rolled his eyes. “Had I known I was in your room today, I’d have called in.”

“Yeah, right. You haven’t called in a single day since you got here,” Bobby scoffed. “The doc’s here and wants to get started. Ellen’s doing the pre-op right now.”

“What?” Dean gestured furiously at the cart of supplies and instruments, and then at his bare table. “Bobby, I haven’t even opened yet. It’s not even a quarter after. Patient’s not set to roll in until seven thirty.”

“I know.” Bobby tore into an airway mask with more force than necessary. “Them’s the breaks. Open fast and I’ll move slow, all right?”

“Dammit,” Dean muttered, eyes scanning the contents of the cart. “Everything better be here, then,” he conceded, reaching for the first package.

It was, thankfully, not a large case; a vein stripping was remarkably straightforward, though he did have to pull his own suture from the racks, keenly aware of the seconds slipping by as he scanned over the boxes of suture to find the ones he was looking for. He hastily popped the packages open onto his table and surveyed the haphazard mound of supplies. He hadn’t had time to open in anything even approximating an orderly fashion; the best that could be said of his back table at the moment was that everything was still sterile and nothing was in immediate danger of sliding to the floor.

“You good for me to bring the patient?” Bobby asked, heading for the door.

“Yeah,” Dean replied, though he still felt like something was missing as he took a mental inventory. Gowns. Gloves. Towels. Vascular instrument set. Suture. Sponges and drapes were in the vascular supply pack, the first thing he’d opened. Everything should be -

“Weitlaners,” he said aloud to the empty room. “Fuck.”

He dashed into the core, where supplies and instruments were stored, and rifled through the container where single-pack weitlaners were kept. “Who do I have to suck off to get goddamn four inch weitlaners when I need them?” he mumbled to himself. “Garth!” he called, peering between the wire shelves. “Do you have any weeties smaller than my head?”

“Room five has them all,” the sterile supply manager called back. “They’re doing parathyroids all day. The ones in your set not good enough?”

Dean swore under his breath as he emerged from the shelving. “Doc’s preference card specifically says four-inch weitlaners. They’re sixes and eights in the set.”

“Well, doc’s in for some bad news,” Garth said apologetically. “Let him know we’ve got them on order for his custom set. Sorry, man.”

“No worries.” Not technically true; Dean didn’t know exactly how the doctor would react to not having the specific instruments he’d requested, or if he’d even notice. Some doctors didn’t, and were just happy with whatever the tech handed over if it did the job. Hoping without much conviction that would be the case, Dean returned to his room.

Bobby had returned from the pre-op holding area already and was helping Ellen slide the patient from the gurney to the operating table. Ellen shot his back table a venomous look and Dean held up his hands innocently.

“I’m gonna go scrub,” he said. “You good here?”

“We’re fine,” Ellen said pointedly, looking at his table again. “Go scrub.”

The water pressure in the scrub sink was, of course, more suited to subduing mobs than washing hands; the front of Dean’s scrubs were soaked with the spray within seconds. Watching the second hand on the clock make its way around the face, Dean almost didn’t notice the man tying a mask to his face as he strode into the operating room, not even bothering to spare a glance for Dean at the scrub sink.

“Hey, Doc,” Dean muttered under his breath, scrubbing a little harder with the brush to spread the yellow iodine suds around. “Good to meet you. I’m Dean, your surg tech today. Not that you give a rat’s ass.”

III

“I’m Ellen Harvelle, circulating nurse,” Ellen announced to the room in a rehearsed tone, holding up a sheet of paper. “And this is Victoria Wilson, patient record number A571942.”

“Correct,” Bobby confirmed from the head of the bed, behind the surgical drape.

“Victoria has consented to a left saphenous vein stripping by Dr. Novak. The consent is signed, witnessed, and dated. She’s had a gram of cefazolin that just finished a few minutes ago, she has a sequential compression stocking on her non-operative side, and her grounding pad is on. Do we all agree to the side, site, and procedure?” She paused for a split-second for the murmurs of assent before turning to Dean. “Dean?”

“Dean Winchester, surgical technologist,” Dean recited. “I have all the instrumentation needed for this case, with additional outside the room should we need it. On the field I have twenty cc’s of quarter percent plain Marcaine, and initial counts have been established. Bobby?”

“Bobby Singer, CRNA,” Bobby’s voice issued from behind the drape. “Victoria’s a reasonably healthy individual with no allergies or comorbidities to speak of, other than a bit of dementia. She’s had her gram of Ancef. Risk of fire is minimal. She’ll get Toradol at the end of the case for pain and she’s got her granddaughter waiting to take her home. I don’t have any other perioperative concerns. Doc?”

“Cas Novak, surgeon,” the doctor said, adjusting a glove. “We’re doing a left saphenous vein stripping, it’s routine, patient should go home today. I don’t anticipate any unusual blood loss. Any additional safety concerns?” He didn’t wait for anyone’s response, instead reaching out to Dean’s back table.

“Need something, Doc?” Dean asked pointedly.

After some time in the operating room, it becomes easy to read facial expressions even if only the surgeon’s eyes are visible. Even so, it was remarkable how much exasperation Dr. Novak seemed to be able to express with just his eyes.

“Just put everything where I can get to it when I need it. Please,” the surgeon added, almost as an afterthought.

Dean nodded. “Everything but my sharps.” He’d placed the red sharps container near his end of the table on purpose.

The blue eyes above the face mask hardened. Dean matched the glare with an even, stubborn look of his own.

“Local,” Dr. Novak said, voice flat.

Dean uncapped the needle and passed the syringe. “Quarter plain Marcaine,” he announced – practically chirped – with exaggerated enthusiasm. He was sure he was supposed to see how the doctor rolled his eyes, even if he ducked his head as he did it.

“Sharp back. Knife.”

Dean was already waiting with the knife; Dr. Novak took it without a word. Dean recapped the needle and watched out of the corner of his eye as he picked up his second knife. As soon as Dr. Novak looked to be done with the incision, Dean cleared his throat.

“I’ve got a fresh blade for you here, Doc. Can I have the skin knife back, please?”

Dr. Novak looked up, blade in his hand hovering over the incision. “You’re one of those, are you?”

“One of those,” Dean agreed amiably.

Without a word, Dr. Novak held out the knife. Surprised at the lack of resistance, Dean handed him the new knife as he took the other. Perhaps this wouldn’t be that bad after all, he mused as he replaced the blade on the knife handle with a fresh one.

“Knife back.” Dr. Novak held it out as he peered at the instruments Dean had laid out. “Do you have weitlanders?”

Dean grit his teeth, as much at the incorrect pronunciation as at the request. “Edge of the pan, on the right,” he said.

“Those are huge,” Dr. Novak said dismissively. “This isn’t a triple-A. Anything reasonably sized?”

“‘Fraid not, Doc,” Dean replied as neutrally as he could. “We don’t have many baby weeties and they’re already open in another room. CS has some on order for your custom set.”

“And that will be fantastic, when they get here,” Dr. Novak said icily, “but does very little to help me right now.” He heaved a sigh as he reached into the pan. “Senns will have to work. Here.”

Dean watched in quiet dismay as the surgeon placed one handheld retractor in either side of the incision. No. Surely he wasn’t going to make Dean hold the incision open for the entire case.

“Here,” Dr. Novak said again, nodding towards the retractors.

Resigned to his fate, Dean took hold of the retractors, contorting his torso to make the most of the awkward positioning. He could only hope that this surgeon was a fast one.

IV

“You can come out with those,” Dr. Novak said absently, tapping one of the retractors. Not losing a moment, Dean withdrew the retractors and put them back down in the instrument pan, then immediately tried to repair some of the havoc the surgeon had wreaked upon his back table. Dean was not an intrinsically neat and tidy person – any glance into the trunk of his car would prove that – but the sight of the black silk strands and hemostats and scissors heaped without any regard to the order of his table had been setting his teeth on edge. For the last twenty minutes he had stood, helplessly holding the retractors, as Dr. Novak had laid waste to the orderly rows of instruments.

Even now, as Dean attempted to set the instruments back as they should be, Dr. Novak was reaching around Dean’s hands and grabbing a handful of hemostats, not appearing to care that he upset the entire rack of instruments as he did so. Dean grit his teeth and added two more hemostats to the hoard that Dr. Novak had amassed up by the patient’s leg, in the hopes that if he had all of them, he wouldn’t rifle around on Dean’s table anymore.

“Blade.”

Dean’s hand was already moving before he even had the chance to register what the order had been. He turned and placed the knife into Dr. Novak’s waiting hand.

“I want to keep this up here. I’m going to be using it a lot and I can’t just wait for you every time. Give me an emesis basin or something to put it in.”

Dean opened his mouth to argue before realizing that he really didn’t care anymore. If it was in a basin, it at least wouldn’t cut through the drapes, and would be visible enough for Dean and the doctor to avoid sticking themselves, and that was all that Dean really cared about. He plunked the kidney-shaped basin next to Dr. Novak’s collection of hemostats and moved his hand just in time to avoid being stuck with the blade as Dr. Novak tossed it in.

Thus began the tedious repetition of vein stripping, a procedure only slightly more interesting than watching grass grow. Dean watched, shifting from one foot to the other, as Dr. Novak made an incision, reached in with the curved vein hook, and withdrew enough vein to clamp with a hemostat. Twisting it until the end he’d cut previously came out of the incision, he’d cut the vein, unclamp it, and then move an inch down the path of the vein in the leg to do it again. Dean noted the multitude of purple ink from the surgical marking pen, where Dr. Novak had mapped out the vein and where he would be stripping, and held back a bitter sigh as he calculated in his head just how much more time they were going to be spending there.

An abrupt, frantic movement, very unlike the deliberate and competent movements the surgeon had displayed so far, forcibly drew Dean’s attention back to what Dr. Novak was doing just in time for him to hear the quiet metallic clatter of an instrument falling to the floor. Immediately Dean’s eyes swept the field, surveying what had fallen, and his heart sank as he realized the casualty simultaneously with Dr. Novak’s “Ellen, can you open another vein hook please?”

“There’s only the one,” Dean said disconsolately, halting Ellen as she turned to go search for one in the core.

Dean felt the surgeon’s incredulous gaze turn to him just as much as he saw it. “What do you mean, only one?”

“We only have one vein hook,” Dean repeated. “It’s not even ours. We’re borrowing it from St. Luke’s. We never did vein stripping here before you came.” He took a breath, but Dr. Novak interrupted before he could continue.

“This is unacceptable.” Dr. Novak took a step back and crossed his arms. “One vein hook? Is sterile supply just incompetent?”

“There are more on order,” Dean interjected smoothly, confident that was the case, “and we can flash this one now.”

“And how long is that going to take?” Dr. Novak demanded.

“Forty minutes, max,” Dean promised, sincerely hoping he was right. “We’ve got an ultrasonic right there in the core. We don’t even have to send it anywhere.”

“And so we’re just going to stand around in the meantime?”

“Doc, you can yell at me ‘til you’re blue as your scrubs while we wait, if it makes you happy,” Dean snapped, “but for the love of God would you please just kick the damn thing behind you so Ellen can get it into the ultrasonic and we can get on with our lives.”

For a crackling, tension-filled moment, Dean worried he’d gone too far; Dr. Novak was glaring at him with open animosity, and from the corner of his eye he could see Bobby standing up to peer over the top of the drape at the head of the bed to see for himself what was about to happen.

Without breaking eye contact, Dr. Novak shifted his weight, and with one foot sent the vein hook skittering across the floor behind him. Ellen stooped to pick it up with a gloved hand and slipped from the room with an approving backwards glance at Dean.

“Give me the three-oh Vicryl,” Dr. Novak said at last, his tone studiously neutral as he stepped back up to the patient’s side. “I’ll close the groin incision while we wait, and finish the rest when the hook comes back.”

Praising whichever god had prompted him to open all his sutures before the case instead of waiting for Ellen to open them at the end, Dean loaded the needle onto the driver and passed it off, sharing a look of relief with Bobby as the apparently placated surgeon set to sewing.

V

“That was the worst of it,” Dean finished, taking a long swig of his beer. “Didn’t apologize when we finally finished, just stormed off to the dictation room. Left me and Ellen to clean and dress the three or four million little puncture incisions he made. And then he basically ignored me completely during the AV fistula later.”

“He’s only there once a week, though, right?” Dean’s brother Sam twisted the lid off his own beer and tossed it to the coffee table.

“Yeah, Mondays. And next Monday is Labor Day, so no one will have to deal with him since we’re closed.” Dean shook his head. “Good thing, too. I can only stand so much arrogant bastard per week.”

“Speaking of the long weekend,” Sam said, leaning forward slightly, “I…have a favor to ask.”

“Yeah? Shoot.” Interest piqued, Dean leaned forward as well.

“You’ve got good taste in jewelry.”

Dean glanced at his bare hands before furrowing his brow. “Obviously.”

“And you’re pretty good friends with Jess, and you know the kind of stuff she likes.” Sam took a deep breath. “I’m gonna start shopping for a ring for Jess this weekend. Was hoping you’d give me a few pointers.” Sam coughed. “I mean, since you already scoped out most of the stores around here.”

Dean shifted in surprise. “Well, I mean – that was three years ago. Half of those stores are gone. But yeah. Of course.” He grinned suddenly. “Finally gonna make the plunge, huh?”

“Dean, we bought this house,” Sam pointed out. “We’ve already well and truly plunged.”

“Yeah, but – all official-like.” Dean reached out and clapped his brother on the shoulder. “Congratulations, man. It’s about time. You’ve been dating for what, fifty years now?”

“Ten,” Sam scoffed, lifting the bottle of beer to his mouth. “But now that I’m finally nearly done with my residency…” He shrugged as he took a drink. “And it took me a while to save up for anything worthwhile.”

“I hear you.” Dean nodded. “Ring I bought – nearly bought, anyway – I hadn’t ever paid so much for anything that didn’t have an engine.”

“You ever hear from her?” Sam asked, entirely too casually.

Dean shrugged. “From time to time. She’s at your hospital. You probably see her more often than I do.”

“Nah. I don’t spend much time in surgery.”

Nodding thoughtfully, Dean picked at the corner of the label on his bottle. “Her taste was a bit different from Jess’s,” he said absently. “You’ll still probably want something that’s pretty from the side, though, so she can wear it around her neck when she scrubs and it’ll still look nice. If the main metal’s gold, have them line it with something that won’t scratch on a chain. Might want a setting that doesn’t stick out, so it doesn’t catch on the neck of the gown. Of course,” Dean amended, “that’s assuming she’s scrubbing forever. I know she was looking at nursing school.”

“She is,” Sam confirmed. “I think she was waiting until I finished up.”

Dean forced another smile to his face. “You two are going to make each other so happy it makes me sick.”

Sam wasn’t fooled; it was nearly impossible to fool his brother. “Hey. You’ll find someone who will put up with you too.”

“Me? Hah.” Dean leaned back and finished the last of his beer with a cavalier swig. “This is Kansas. Not the friendliest place to be openly…whatever. Not straight.”

Sam coughed. “I know it’s rough, man. I wish I could do something to make it easier.”

“Easy? I don’t want easy.” Dean shook his head forcefully. “Easy would have been marrying Cassie and pretending. Hell, she’d probably still say yes if I went and asked her right now. But the easy way was wrong and…” Dean trailed off, then shrugged. “This may not be great, but I’d be miserable pretending, and so would any girl I subjected to that.”

“At least you know now,” Sam offered weakly.

“However much good that does me,” Dean replied darkly. He shook his head. “Sorry. Didn’t mean to bring you down. There’s a really good jeweler on the Missouri side of downtown. I’ll give him a call and tell him to expect us on Saturday.” He smiled, and it was mostly genuine, even if the corners of it drooped as he tossed the empty beer bottle into the garbage and started up the stairs to his room.


	2. Interlude: Blue Velvet

**Notes for the Chapter:**

> Silver and gold shone against the backdrop of blue velvet. Dean gazed steadily at them, though the soft focus of his eyes made it apparent he was seeing none of it.

“It’s a lost cause, then?” the jeweler behind the counter asked sadly.

Dean exhaled in a single bitter laugh. “Yeah. Me. I’m the lost cause.” He swallowed. “She needs someone who isn’t me. Let’s leave it at that.”

The jeweler sighed. “I hadn’t started on it yet. I can refund most of your deposit.”

Dean looked up. “I thought the deposit was non-refundable.”

Shrugging, the jeweler pinned Dean with a knowing look. “You’ve just suffered a deep disappointment. Be cruel of me to add insult to injury.” His eyes grew distant. “Would have been a beautiful ring, though.”

The corner of Dean’s mouth tugged in a forlorn smile. “She’s a beautiful girl.”

Cash changed hands; Dean did not even bother to count the bills that he shoved in his wallet, fingers trembling slightly. As he pulled the hood of his sweatshirt forward to ward against the chill autumn drizzle outside, the jeweler cleared his throat.

“Call me nosy, but – what happened that’s so impossible to make better?”

At first it didn’t look like Dean was going to answer. Then,

“I’m not straight.”

The bell above the door jingled as Dean pushed against it. The jeweler watched him slide into his car and roll away from the curb, face still set into that deadened serious expression.

“That’d do it, I suppose,” he said to himself. He let his eyes wander about his shop for a few moments, at a loss for what to do, and found himself hoping that the young man would find someone else to make him smile one day.


	3. September: Complicated and Quiet

**Notes for the Chapter:**

> I

The morning clouds had broken, leaving a warm, if muggy, Labor Day in their wake. Dean plunged his arm into the barrel of ice to fish out a beer. The shock of the cold against his skin was a pleasant contrast to the heat of the day, and his fingers grew numb before they closed around the neck of a bottle hidden in the slurry of ice and water.

Twisting the lid from the bottle, Dean scanned the park, locating the clusters of people scattered throughout. Most of the other surgical technologists were gathered by the pond, watching an unseasonably late clutch of adolescent ducklings. Sam hung at the edge of the group with Jess, dutifully fulfilling the role of “awkward plus-one at a company picnic.” It appeared that Billing was trying and failing to start a volleyball game, and that most of the surgeons were sequestered in a gazebo, attention either glued to their phones or their paper plates of picnic fare.

Dean took a step towards the other techs at the pond before a lone, dark-haired figure on the other side of the pond caught his eye. He was sitting under a tree, apparently watching the proceedings, and his posture as well as the angle of the beer bottle when he drank from it indicated he’d been there for some time. Dean squinted. From this distance, he didn’t recognize the person – strange, given how small the staff at the surgery center was. Dean knew nearly everyone by sight if not by name.

On impulse, Dean grabbed another beer from the ice barrel before striding purposely toward the tree.

“Hey,” he said casually as he approached. The man looked up in mild surprise. Dean blinked and the shy smile that leapt to his face was too honest to suppress. This close, Dean still didn’t recognize him, but the several days of scruff on the stranger’s cheeks combined with the lines by his eyes when he smiled did interesting things to the pit of Dean’s stomach. He took another few steps and held out the second beer. “I’m Dean.”

The stranger blinked, slightly puzzled, and as he reached for the proffered bottle the sunlight caught at the cerulean blue of his eyes in such a way that the pleasant tumble in Dean’s stomach turned into a yawning plummet of belated recognition. He swallowed, his tongue suddenly leaden in his mouth. “And you’re Dr. Novak,” he said in a slightly strangled voice.

“Last I checked,” Dr. Novak said with another small smile. “Thanks.” He lifted the beer in a salute.

Dean realized he was staring and he bowed his head for a moment to scratch at the back of his neck, words trying and failing to present themselves for duty.

“I worked with you last week, didn’t I?” Dr. Novak asked, squinting up at Dean. He held up a hand to shade his eyes from the sun, and out of courtesy as much as to compensate for his inexplicably wobbling knees, Dean folded himself onto the ground beside the surgeon.

II

“Pretty sure everyone just thinks I’m some random guy who wandered into the picnic and won’t leave,” Dr. Novak said with a quiet chuckle. Dean took another hasty swallow of his beer to cover his confusion at the sound; five minutes ago he’d have pitted his paycheck against Dr. Novak even knowing how to smile, let alone laugh. “I’ll probably be ‘the new guy’ for months. That’s what I get for being a wallflower, I suppose.”

“What brought you to Summit?” Dean asked, curiosity managing to overpower his shock.

“Chance,” Dr. Novak said, shrugging. “And a headhunter, I suppose.” He smiled down at his knees at the small jest, and Dean coughed at the ridiculous flutter in his chest. “Really, it came down to the fact that there was nothing keeping me in Seattle, and the chance to turn over a new leaf here. So here I am.”

“Seattle, huh? What did you do there?” Keeping the surgeon talking was suddenly foremost on Dean’s list of important things to accomplish.

Dr. Novak shrugged. “School, college, med school, residency, fellowship – pretty much everything. Was on the heart team at Overlake Hospital for a year before I left.” He shook his head. “High stress. Way too high. Turned me into a royal douchebag, if you believe my ex.” Raising the beer bottle to his lips, he added, with a slightly bitter cast, “He left me a while back. Said I didn’t know how to ‘turn off’ when I got home.”

“‘He?’“ Dean asked, his mouth speaking before his mind could decide whether it was a good idea.

Dr. Novak lowered the bottle, expression suddenly guarded. “Is that a problem?”

“What? No,” Dean replied hurriedly, feeling suddenly cold. “God, no. Not at all. I just –” He groped for the words he wanted so desperately to say. “It’s hard to find other people who are open about that, in this part of the country.”

Looking significantly more relaxed, Dr. Novak nodded, with an appraising sidelong glance that made Dean wish he could take back the words he’d said. “And have you been looking?” he asked slowly.

Dean swallowed, suddenly fascinated with the pond in front of him. This wasn’t Sam or Jess, or even Jo, any of whom he could casually joke with, the careful foundation of trust already laid. “It’s complicated,” he said finally, surprised by how flimsy his voice sounded.

“Ah.” Dr. Novak’s voice was mild; Dean didn’t dare look to see what expression matched it. “Complicated and…quiet, I take it.”

Dean nodded. “More or less.” He chanced a look back at the surgeon, who was contemplating the ripples dancing on the surface of the pond in front of them.

“How long have you been a scrub?”

Grateful beyond measure for the subject change, Dean took another long swallow of his beer to wet his lips. “Going on four years now.”

“Really?” Dr. Novak sounded surprised. “What did you do before?”

Dean was used to the question; he was not used to the impulse to be honest. He hesitated, taking a readying breath. “Road construction. Odd jobs.” He looked down at his hands. “Pretty much anything that didn’t need a high school diploma or a social security number.”

It was clearly not the sort of answer Dr. Novak expected. “You’re joking,” the surgeon said after several beats of silence, disbelief plain in his voice.

Dean shook his head. “I, uh…I used to have a rough life.” He nodded over at the group of techs on the other side of the pond. “If it wasn’t for my brother and his girlfriend, I’d probably still be living it.” When the surgeon didn’t say anything more, he chewed his lip for a moment before continuing. “Jess, there – she’s been a tech for years, and she helped me get my –” he almost said _GED_ before biting it back – “certification, after we moved here for Sam when he got into Kansas State for medical school.” He nodded faintly. “They let me live with them while I got my feet under me. They’re probably the reason I’m not facedown in a ditch somewhere.”

He chanced a look to the side; Dr. Novak was staring at him intently. “I never would have guessed,” the surgeon said slowly. “You seem so…grounded.”

Dean scoffed. “That’s a new one. I usually hear ‘cocky.’”

Dr. Novak exhaled in a soft laugh. “That, too.” He glanced to the side, catching Dean’s eye. “Most techs at Summit seem scared of me. You’re the first that doesn’t.”

Dean smiled gamely. “Takes a lot to scare me. You’ll have to do better than that.”

III

The three empty beer bottles stood in a line between them, the late afternoon sun glinting from the brown glass as the shadows shifted in the wake of Dr. Novak’s wild gesticulations.

“It’s not that I don’t like using a tech,” he said seriously. “Just that I got used to working without one. All the techs I’ve worked with prioritize assisting full surgeons over fellows, and when I was a full-fledged surgeon – emergency heart cases are huge. Two or three tables, sometimes, or more – and if I need something  _now_  and the tech is focused on another surgeon –”

“Dude, I scrub heart cases when I’m taking call for St. Luke’s,” Dean interrupted. “If a tech can’t keep up with two surgeons and a PA, he needs to go back to carpal tunnels and tonsils.”

“You scrub for St. Luke’s, too?” Dr. Novak asked.

“I take call on holidays,” Dean corrected. “Hardly ever get called in and I get paid for sitting on my ass at home. But just because I spend most of my time scrubbing foreverectomies and eternal vein strippings doesn’t mean I can’t hustle.”

“Hey,” Dr. Novak protested, but with a smile, “that vein stripping would have gone smooth as butter if  _someone_  hadn’t dropped the vein hook.”

“Pretty sure that was the surgeon who dropped it,” Dean pointed out, “on account of him not letting me pass him anything because he doesn’t like using a tech.”

“I let you pass me things.”

“Only because I didn’t want you throwing my sharps around the room, so I held them hostage.”

“Throwing? I’m throwing things now?” Dr. Novak looked thoroughly amused.

“Give it another week and my story will be that you threw the vein hook at me in a fit of rage over the weitlaner size,” Dean assured him with a grin.

“You’re going to scare all the techs away,” Dr. Novak warned.

“They’re already scared,” Dean pointed out. “Looks like you’re stuck with me.”

“Woe betide me,” Dr. Novak replied drily. He looked down at his hands, and a thread of confusion wound around the warmth in Dean’s middle as the surgeon’s face fell slightly. “In that case, can I apologize in advance for my…” Dr. Novak trailed off and he huffed out a sigh. “I know I’m not easy to get along with,” he said finally, looking back up. “It’s something I’m working on. It’s hard to maintain a behavioral filter when you’ve got a vein flayed open, and I’ve…developed bad habits.”

Nodding, Dean licked his lips. “I get it,” he said, the words feeling inadequate. “You do your thing. If you need to curse someone out to feel better, I’ve got a thick skin.” He cracked a smile. “My entire purpose is to make things easy for the surgeon.”

IV

“So who were you flirting with the entire time?” Sam asked from the back seat of the car as Dean backed out of the parking space.

It was several seconds before Dean realized the question was aimed at him. “I wasn’t flirting with anybody,” he replied in confusion.

“Dean, I’ve seen you flirt before. You were in hardcore flirting mode.”

“That was Dr. Novak. I was being  _sociable_ ,” Dean stressed. “He’s new and doesn’t know anybody.”

“Isn’t he the asshole you told me about?” Sam asked, raising an eyebrow where Dean would see it in the rearview mirror.

“He’s not an asshole,” Dean replied, surprising himself.

“He made Jo cry,” Jess pointed out. “He’s kind of an asshole.”

“No more so than Angeles, when he’s in a bad mood,” Dean insisted. “He’s actually a really nice guy. You two would like him.”

“Right,” Jess said dubiously. “I count my blessings that Mondays are my days with Dr. Milton, because it means I’ll never have to go to Novak’s room. Didn’t he drop something and blame you for it?”

Dean rolled his eyes. “It’s possible I exaggerated the story to make it sound good,” he admitted. “Trust me. I spent the afternoon talking with the guy. He knows he’s a douchenozzle in the operating room. That’s how he vents the stress. He’s taking apart someone’s circulatory system. He’s allowed to be stressed.”

“Maybe, but it doesn’t give him a free pass to be a dick to his techs,” Jess said firmly.

“No,” Dean conceded, “but – look, I’m not championing the dude. I’m just saying that he’s like a completely different person when he doesn’t have the scrubs on. He’s almost someone I could hang out with. That’s all.”

“Almost?” Sam asked.

“He’s a surgeon,” Dean pointed out. “Surgeons don’t hang out with techs. It’s like a law of nature.”

“He’s right,” Jess said to Sam. “They usually won’t even go to the lounge to eat lunch with the techs and nurses. It’s an unwritten rule, even if they have favorites.”

“You make it sound like high school all over again,” Sam said, shaking his head.

“No,” Dean disagreed. “It’s a royal court. The merchants don’t dine with the nobles – and anyone with letters after their names are nobles.” He nodded to himself, pleased with his analogy. “The noble might even like the merchant – but he wouldn’t ever bring one home.”

“Not sure I like being a noble in your scenario,” Sam said as he settled back in his seat. “Does that mean I have to dump my merchant girlfriend?”

“Watch who you’re calling a merchant, noble boy,” Jess remarked, leaning over as much as her seat belt would allow to lay her head upon Sam’s shoulder.

“No necking in my car,” Dean called back, and laughed as Sam planted a noisy kiss on Jess’s forehead. He accelerated onto the freeway into the afternoon sun, the asphalt rolling away as they headed towards home.


	4. September: Tall Tales and Dubious Fables

**Notes for the Chapter:**

> I

Dean slammed his hand down on the snooze button of his alarm and groaned. Monday. No – Tuesday. It had been a long weekend, which meant a short week. Briefly cheered by the prospect, Dean threw off his covers and made his way to the shower.

Tuesday. Dean scrunched his eyes shut as the hot water ran down his face. Who were the doctors on Tuesdays? Definitely Angeles, and probably Cage – Dean was willing to bet he’d be in one of their rooms. With a strange pang it occurred to him that Dr. Novak wouldn’t be back in the operating room for another week; he wondered why he cared.

Even after years of routine, Dean found it difficult to be truly awake at such an early hour. It wasn’t until he’d pulled his car into the parking space at the surgery center that he shook his head and felt truly alert, and even then he still felt like a zombie as he shambled up to the third floor to the locker room and, more importantly, the boards.

“Angeles,” he said aloud after staring at them, bleary-eyed, for several moments. He groaned at the list of procedures; they almost seemed to be hand-picked to make for the most sleep-inducing morning possible.

“What’s wrong?”

Dean looked to the side. “Morning, Kevin.” In response to Kevin’s question, he jabbed his finger at the list of cases for Dr. Angeles’s room that day. “Two – not one, but  _two_  ESWLs, a TURP, and then three bladder biopsies.”

“I haven’t done an ESWL yet,” Kevin said thoughtfully.

“If they ever ask if you’d like to do one, tell them you’d love to, but you have some paint you need to watch dry,” Dean said wryly. “You’ll enjoy yourself more.”

II

“Pamela Barnes, circulating nurse. I have Brian Foster here today who has signed, witnessed, and dated a consent for Dr. Gabriel Angeles to perform an extracorporeal shockwave lithotripsy on his left side. He did not need any pre-op antibiotics, his warming blanket is on, and his SCDs are on and running. Dean?”

Dean took a deep breath. “Dean Winchester, surg tech. We’ve also got Ash here from radiology. There is no instrumentation required for this case, no medication or fluids required for this case, and no supplies to count for this case. Ezra?”

“Ezra Moore, CRNA,” the nurse anesthetist drawled. “Brian’s healthy with some hypertension that’s well-controlled and has no allergies. We’ll do some Toradol for the pain at the end. I don’t have any other peri-op concerns. Doctor?”

“Dr. Gabriel Angeles,” Dr. Angeles announced in a booming voice. “I’m a Taurus, and I enjoy Yahtzee and a good martini…” He looked around the room at the pained expressions. “Tough crowd. Dr. Angeles, surgeon. I – by which I mean Ash – is going to be performing an extracorporeal shockwave lithotripsy, no blood loss, nothing unusual, he’ll go home, and that’s all she wrote. Shall we begin?”

“Ready when you are, doc,” the radiology tech said with a lazy salute.

“Well then, let us begin.” Dr. Angeles stepped up to the giant C-shaped machine that curved around the bed. “Can I push the button?”

Ash gestured expansively at the control unit of the machine, and with exaggerated glee, Dr. Angeles pushed the button. The machine began clicking loudly at a measured pace, and Dr. Angeles lifted his arms in a celebratory gesture. “All right! I’ll be in my office.”

He did not, of course, leave the room – even if the machine was technically doing all the work of the ultrasound surgery, and it would be the radiology tech who would take over if anything went wrong, the surgeon still needed to be in the room, as did the surgical technologist. To Dean’s surprise, the surgeon did not plant himself in front of the computer to busy himself with his email, but pulled up a rolling stool next to Dean’s and seated himself.

“So I hear you butted heads with Cas the other day,” Dr. Angeles said smugly.

“Cas?” Dean asked blankly, before the name clicked. “Oh. Dr. Novak. Uh, yeah, we…had some friction.”

“And not the good kind.” Dr. Angeles chuckled. “He’s a nice guy, when he gets the stick out of his ass.”

“You know him?” Dean asked.

“Oh yeah. Cas and I go way back. We were frat brothers.”

Dean blinked. “Say that again?”

Dr. Angeles chuckled. “Phi Delta Epsilon, baby. I was Pledgemaster the year he pledged. Tough little son of a bitch.”

“Dr. Novak was in a fraternity?” Dean asked in disbelief.

“Kind of skews your perception a bit, doesn’t it?” Dr. Angeles grinned. “But allow me to make your world view more comfortable: PhiDE was a professional fraternity. Pre-med. I think we may have thrown a party  _once_ while I was there, and it was by accident.”

“That…makes more sense.” Dean, of course, had never been in a fraternity, but he’d seen movies, and fitting the quiet, stodgy Dr. Novak into any of those roles made his head hurt.

“Don’t let that throw you off, mind you.” Leaning back and crossing his arms, Dr. Angeles smiled in fond reminiscence. “Cas tended to get in over his head at times. Like the time he woke up half-naked in a sorority house.”

Dean turned his head to look sharply at the surgeon. “What?”

Dr. Angeles snickered. “Oh, it confused the living hell out of him until he slowly remembered – it was the LGBT house, and the girls next to him were gayer than he was – they just wanted to make sure he didn’t die from alcohol poisoning. They even washed his clothes for him after he got sick all over them.” Dr. Angeles shook his head, clearly amused. “We still gave him a hard time about it for weeks. It was more action than most of us got, after all.”

Dean realized his eyebrows had climbed to previously unforeseen heights. “I’m…having trouble believing you,” he said. “In other words: I call bullshit.”

“Oh,” Dr. Angeles said, leaning forward and rubbing his hands together. “We’ve got forty minutes left of this ESWL. I’m just getting started.”

III

“Doc,” Dean asked, eyes scanning the sheet of orders for the next case, “why did you order a flexible ureteroscope for a stent removal?”

“Oh,” Dr. Angeles said with relish, “let me tell you about this patient.”

Dean raised an eyebrow. “Okay?”

“This patient – actually, I think you might have scrubbed his stent placement. Back about two years ago.”

Dean’s other eyebrow shot up to join the first. “Two  _years_?”

“And you have reached the crux of the story in record time. Yes. Two years.” Dr. Angeles tapped a key on the keyboard, and a set of x-rays appeared on the screen. “He was supposed to come back in two weeks. He had an appointment. But instead, he went to Jamaica for three months, and then ignored every attempt to get him to come back in. Now, two years later –” he pointed at the very clear outline of the stent on the x-ray. “His stent has not only migrated most of the way up into his kidney, but it also has essentially become a calcium-encrusted, spiral-shaped kidney stone with a smooshy silicone center.” Dr. Angeles shook his head in disgust. “Short of going to his home with a tranq gun and removing the stent in his living room, there was literally nothing more I could do to get him to come in. So. We’re going to shoot some ultrasound at him and hope it loosens up the calcium deposits enough for me to get the stent out.”

Letting out a long breath, Dean shook his head. “So what you’re saying is that you’re finding your career in urology to be gratifying.”

“You know the clincher that makes me so honored to be sharing my medical knowledge with this man?” Dr. Angeles asked as he stared at the x-ray. “Getting this stent out is going to cause some severe ureteral trauma. Which means I’m going to have to insert another stent and have him come back to the office in two weeks.”

Dean’s jaw dropped. “You’re kidding.”

Dr. Angeles shook his head. “I’m considering installing a bungee while I’m in there, so he doesn’t get too far without me being able to make him come back.”

The x-rays were even more unsettling up close. Dean winced; he wasn’t trained to read x-rays, but even he could see that the stent did not look like it should. “Why would anyone sabotage themselves like this?”

“Dean,” Dr. Angeles said seriously, “when you’ve been doing this for as long as I have – and I haven’t even been doing it for all that long – you learn one thing very quickly.” He pointed at a particularly sharp-appearing protuberance on the x-ray. “Sometimes, patients are just downright stupid.”

IV

“So I go to meet him,” Dr. Angeles said, eyes focused on the video screen to the side of him where the scope displayed the inside of the patient’s bladder. “He’s got a twit-grin three miles wide and he shoves an envelope at me.”

“Acceptance letter,” Dean guessed.

“Bingo. First choice, University of Washington Department of Medicine – same as me. I of course offer to buy him a drink.”

“Of course.”

“This turns into – fuck. Biopsy forceps.”

Dean grabbed the elongated forceps from the table and handed them to Dr. Angeles, who fed the scope through the channel in the forceps and threaded the entire apparatus back into the patient’s bladder.

“Anyway. This turns into several drinks. And – you may have noticed that Cas is not an ugly individual.” Dr. Angeles glanced away from the screen and turned to shoot a brief, arch look at Dean.

Dean coughed. “I have the right to remain silent.”

Dr. Angeles smirked as he turned back, and the conversation paused as he maneuvered the forceps into position to collect a piece of suspicious tissue growing from the bladder wall. “He was no uglier with a baby face, either. Ladies and gents alike were willing to celebrate with him in the traditional method of exchanging ethanol in various forms.” He withdrew the forceps; Dean reached forward and collected the tiny piece of tissue on a piece of wet gauze. “Left anterior bladder wall biopsy,” the surgeon said, and the nurse hastened to scribble down the name of the specimen. “It can go in formalin. Cautery?”

Dean snatched the electrocautery wire and handed it to the surgeon, who threaded this down into the patient’s bladder and began the arduous process of stemming the bleeding that taking the biopsy had caused.

“Next thing I know, we’re back at my place. It’s nearly one in the afternoon, my arm hurts like hell, and I’ve got this bandage.” Dr. Angeles indicated a spot on his bicep. “I take the bandage off and –”

“No,” Dean said, suddenly catching on to what this story was.

“Oh, yes. I will admit, I’ve grown fond of my little coyote tattoo in the intervening years. Cas, though…”

“He didn’t.”

“Not only did he,” Dr. Angeles continued, squinting at the video screen. “But he went whole fucking hog. The outline covered half his back. It was big enough –” Dr. Angeles stopped to laugh. “It was big enough that the tattoo artist couldn’t finish it in one night. So Cas spends three weeks trying to decide whether to pay to get it removed, or pay to have it finished and end up with a giant tattoo all across his shoulders.” He watched the screen intently for a few moments before nodding in satisfaction. “We’re done here. We ready to debrief?”

Pamela, who had been hanging on every word of Dr. Angeles’s story, blinked. “Bladder biopsy, one specimen in formalin, bleeding controlled, patient going home. Sound right?”

“Sounds good.” Dr. Angeles peeled off his gown and gloves. “I will bet every dollar in my wallet right now that Dr. Novak still has that tattoo. He might even show you if you ask really nicely.” He winked outrageously at Dean, who shook his head in amusement as he gathered the various wires and cords that connected the cameras and light sources to the scope and coiled them carefully, eyes downcast to hide the inexplicable flush that bloomed suddenly at the back of his neck. It was warm in the room, he reasoned. That was all.

V

“Do you think he’s telling the truth? About Dr. Novak?” Pamela asked Dean near the end of the day, pulling tubes from hanging saline bags to make it possible to remove the drapes from the last patient.

“Dr. Angeles is the king of tall tales,” Dean said in a practical tone as he wadded up the blue plastic table drape and turned to begin pulling the surgical drapes off the patient. “And he knows he can bullshit with the best of them. I’m telling you, I talked with Dr. Novak for hours yesterday.  _I’m_ more of a party animal than he is.”

“No, about the –” Pamela lowered her voice. “About him being gay.”

“That much is true,” Dean admitted. “He point-blank told me. He’s not exactly shy about it.”

“Damn.” Pamela shook her head. “That’s a shame. I wouldn’t mind asking to see his tattoo.”

“Hon,” Ezra said as she removed the clips that held the surgical drapes to the IV poles at the head of the bed, “ _I_ wouldn’t mind asking to see his tattoo, and I’m old enough to be his mother. I say we ask him anyway. Maybe he’ll be kind.”

Silence, Dean decided, was the best option for responding to this particular exchange, and he busied himself with bunching the armful of drapes into a ball to shove into the garbage while, thankfully, Pamela and Ezra returned to their duties to the patient.

Nothing more was said about Dr. Novak, but Dean’s mind insisted on lingering over the unlikely stories long after he’d traded his scrubs for his street clothes.


	5. September: Going to be Useful

**Summary for the Chapter:**

> I

It was called the Cage; likely it had gained the nickname by the three walls of wire-enforced windows that allowed to charge nurse to overlook all of the bustling activity of the surgery floor. Dean’s knock on the open door of the Cage didn’t seem to catch the charge nurse’s attention, so he repeated it.

“Yes,” Chuck said, not taking his eyes from the computer screen or turning around, “Kevin was supposed to be in that room. Dr. Novak requested you instead.” Chuck hit the enter key with force and then twisted in his chair. “Given his tendency towards outright disrespect for every other tech I’ve ever assigned to his room, I’m going to take this as a good sign that I might somehow be able to cobble together some sort of team he can work with, and that I won’t have to tell the OR manager that our only vascular surgeon is a completely antisocial dickwad who no one wants to tech for.”

Dean blinked. “That, uh, wasn’t my question. You’ve got me working next week, and I asked for it off months ago.” He furrowed his brow. “Dr. Novak _requested_  me?”

“Ducked his head in about ten minutes ago.” Chuck leveled a finger at Dean. “You keep him happy. We can’t afford to lose the OR hours he has booked with us if management decides he’s more trouble than he’s worth.”

Holding up his hands, Dean tried to look supplicant. “I’ll try. Next week…?”

“Right. I’ll fix the schedule. All week?”

“Please.”

“Consider it done. Oh, and check your case cart – there should be a new instrument set on it, and if it’s not, let me know and I’ll get on Materials Management’s case.” The phone rang and Chuck reached to answer it, leaving Dean to slip back out into the corridor and begin his day.

II

“Still not checked in yet?”

Bobby shook his head in response to Dean’s question. “Note here says the front desk called the patient and got no answer.”

Dean grimaced. “Doc’s going to throw a fit.”

“What do you want me to do about it?” Bobby asked irritably, crossing his arms and glaring at the computer screen.

“Nothing, but I’m not opening until the patient checks in,” Dean replied, crossing his own arms and leaning against the wall. “I’m not gonna waste money if we end up having to cancel.”

“Good call,” Ellen said behind him. “Just don’t disappear – we’re going to rush her through pre-op and we’ll need you ready.”

“I’m not going anywhere,” Dean assured her.

There was a thud as the doors to the room were pushed inward to admit Dr. Novak, eyes hard as he glanced around the room. “Would anyone care to tell me what is going on, and why we’re just standing around?”

“Your patient isn’t here yet,” Ellen said quickly in a challenging tone. “The room’s ready for her whenever she decides to show up.”

“It doesn’t look very ready,” Dr. Novak retorted, eyes landing on the undraped back table and the unopened supplies on the wire case cart. Even without a mask, he resembled the placid man at the edge of the pond last week only in stature; even his voice was harder, his posture more akin to a coiled spring than a lounging cat.

“This’ll take me fifteen minutes at most,” Dean said firmly, “and I don’t want nine hundred dollars of supplies to be made useless if I open them and your patient cancels. I’m at least waiting until she checks in.”

“She’s not canceling. Get the case open now or I’ll open it myself.” Dr. Novak reached for the plastic dust cover of the package sitting on the table. Dean stepped swiftly in front of him.

“Doc. I got this. Trust me.” Dean met Dr. Novak’s stubborn gaze with one of his own, ignoring the incongruous step sideways his heart took in his chest as Dr. Novak’s eyes narrowed.

“Patient just checked in,” Bobby announced into the crackling tension. “Just in case anyone isn’t too busy posturing to care.”

Dr. Novak’s eyes didn’t leave Dean’s. “How long until she’s through pre-op?”

“Forty minutes at the least,” Ellen responded.

Dean desperately wanted to swallow. It really wasn’t fair, how piercing Dr. Novak could make his eyes, and they took on the hue of the scrubs they wore to appear an even colder blue than they naturally were.

“Page me if the room is ready before eight thirty,” the surgeon said finally, stepping aside. “I’ll go wait for the patient in pre-op.”

Breathing freely once again, Dean first allowed himself a quiet sigh of relief before he reached out to grab something from the cart. “Hey, Doc! This might cheer you up.”

Dr. Novak turned, and Dean held up the blue-wrapped box that very plainly had “DR. NOVAK’S VEIN STRIPPING EXTRAS” scrawled across the striped indicator tape. Dr. Novak stared for a moment, his eyes flickering between Dean and the box, before a very small smile quirked the corner of his mouth.

“It’s about time,” he said, but the words had no real edge to them. “See you in forty.”

III

Time-out completed, Dr. Novak held out a hand. “Local.”

“Quarter Marcaine with epi,” Dean said as he handed over the syringe, uncapping the hypodermic needle as he went.

“Sharp down. Fifteen blade.”

Dean handed the surgeon the knife, carefully sliding the hypodermic needle back into its cap to rest beside the red sharps container until it was needed again.

“Sharp down. Pickups and Bovie, please.”

Dean blinked, but his hands were moving before his mind caught up with the commands, passing Dr. Novak the forceps and shaking the electrocautery pencil free of excess cord before placing it in the surgeon’s waiting hand.

The characteristic scent of cauterized flesh began to permeate the air, detectable even through Dean’s mask; at one point the smell had made Dean swear off Corn Nuts for the rest of his life, but now it just made him vaguely crave barbeque. One really could grow accustomed to anything, Dean supposed.

“Small weitlander,” Dr. Novak said, jerking Dean out of his momentary reverie.

“Weitlaner,” Dean corrected automatically, his mouth taking initiative before checking with his brain to determine whether this was a wise course of action. He suppressed a grimace as he held out the retractor.

“Excuse me?” Dr. Novak asked, not taking the retractor.

“It’s ‘weitlaner.’ No d.” Dean wanted to squirm under the puzzled scrutiny. “Sorry. Pet peeve. Carry on.”

“Weitlaner,” Dr. Novak said musingly as he took the retractor and positioned it to hold the incision open. “That name makes even less sense. Debakeys and Metz.”

Dean had passed the smoother forceps and the tissue scissors before it occurred to him that Dr. Novak had even asked. Bemused, he looked across to Ellen, who hadn’t seemed to notice anything.

“How many instruments do techs even know?” Dr. Novak asked as he dissected down further to reach the deep vein.

Dean considered for a moment. “Hundreds,” he replied. “Maybe even one or two thousand. Some of them have several names. Kochers can also be Oschners or Rochesters, depending on the coast the doctor is from.”

“Hmmm. Snap.”

Thoroughly suspicious now, Dean handed Dr. Novak the hemostat, and on a hunch, readied himself with another. Sure enough, Dr. Novak’s second call of “snap” came a few seconds later, followed closely by “tie.”

“Free or on a passer?” Dean asked. He’d loaded several strands of the silk onto small hemostats already, in preparation for Dr. Novak taking over his table as he had last time, but Dean got the distinct feeling that today was going to progress somewhat differently.

“Free is fine. Can you hold that?” Dr. Novak indicated one of the hemostats he was holding; Dean passed off the length of silk and took the hemostat, holding it while the surgeon tied the silk tightly around the vessel it was clamping. “Thanks. Come off now and cut that – leave two millimeters on the tails. Pickups back.”

Dean handed Dr. Novak the forceps with his free hand while he unclamped the hemostat with the other, then grabbed the scissors and cut the excess ends of the silk. This time when he looked up at Ellen she was watching with disbelief. He shrugged as he set the hemostat back on his table with the others and palmed the scissors; it looked like he was actually going to be useful today.

IV

Dr. Novak worked silently for several minutes before clearing his throat. “So Gabriel told me that you two had an interesting conversation last week.”

Heat rushed to the tips of Dean’s ears, and he resisted coughing guiltily. “I was more of a captive audience. Dr. Angeles likes to hear himself talk.”

Dr. Novak didn’t laugh, but Dean could see the crinkles at the edge of his eyes that either meant a smile or a grimace. “That is a very accurate statement. Snap.”

The hemostat changed hands again. “So you knew him in college?” Dean asked politely.

Dr. Novak looked up as he held his hand out in wordless request for another hemostat. “Didn’t buy the fraternity story, did you?”

Feeling significantly more at ease, Dean handed the surgeon another hemostat. “He does tend to make up a lot of things from whole cloth. I didn’t actually believe he had a wife until I met her.”

“Oh, trust me. I know his fondness for a good, believable lie better than anyone.” Dr. Novak placed the handles of the hemostat into Dean’s waiting hand as he took the black silk, threading it around the vessel and knotting it with dexterous fingers. “But that wasn’t whole cloth. We  _were_  PhiDE brothers.” Once again, he held the ends up for Dean to cut.

“Wait. You were in a frat?” Ellen asked, turning her head from the computer where she sat.

“Everyone is always so surprised,” Dr. Novak said with a wry air. “Vein hook and skin knife. Is it really that hard to believe?”

“Yes,” Dean and Ellen said simultaneously.

“Well.” Dr. Novak shook his head, and Dean was almost certain that the wrinkles around his eyes were from a grin. “Assume that anything Gabe tells you is at least based on a grain of truth.”

“Even the tattoo?” Bobby asked from behind the drapes, adding his voice for the first time.

“The tattoo story is possibly slightly exaggerated,” Dr. Novak conceded.

“How so?” Ellen asked with interest, but at that exact moment, Dr. Novak’s vein hook brought up a fragment of saphenous vein that was very determined to drain itself.

“Shit. Snap!”

It was no danger, simply messy; the blood pooling on the field would clot if Dean didn’t do something about it, and that wasn’t pleasant for anyone. While Dr. Novak continued excising small fragments of vein, Dean busied himself with mopping up the blood and keeping up with the surgeon’s puzzling requests for instruments. The requests themselves were not puzzling – hemostat, scissors, vein hook, all in a simple pattern that Dean had memorized the last time Dr. Novak had performed this surgery with him.

What struck Dean as so puzzling was that for no reason that he could tell, Dr. Novak was no longer averse to using a tech.

V

The bottle of enzyme treatment spray was empty. For a short moment Dean considered leaving his instruments in the dumbwaiter without spraying them, then looked again at the blood that was beginning to dry in gummy brown splashes on every item in his instrument pans and he sighed. Garth would give him an earful if he sent down bloody instruments again. He and the new central sterile supply manager were only just beginning to get along; the last thing Dean needed was a petty workplace feud.

With a heavy sigh, Dean reached up to grab the gallon jug of the enzyme treatment solution. The sweet chemical odor of it made his eyes water as he carefully decanted it into the neck of the spray bottle.

The door to the dirty utility room opened, clattering loudly against the cart full of Dean’s instruments and knocking one of the full suction canisters to the floor. The lid, thankfully, held, and the canister rolled into a corner as Ellen stuck her head into the tiny room.

“Dean? You in here?”

“Back here,” Dean said, looking balefully down at the copious amount of enzyme treatment fluid he’d slopped down his front at the sudden noise.

Ellen squeezed the rest of the way into the room and stooped to pick up the canister, depositing it into one of the biohazard collection bins. “What the hell did you do?”

“Come again?” Dean asked, furrowing his brow as he screwed the cap back onto the gallon jug. Now appropriately armed with a full spray bottle, he began to spray his instruments with the chemical that would break down the thick residue of blood and tissue.

“Dean, I’ve been the circulator in that room since he got here five weeks ago. He doesn’t like techs. He doesn’t use techs. He made Jo cry because she was getting in his way. Seriously, what did you do?”

Dean grunted. “Look, Ellen, I know you love Jo like a daughter, but you’ve circulated with her. She’s not fast. She’s hideously smart and she knows her shit, but she takes her sweet time. Dr. Novak used to be on a heart team. He’s used to getting things he wanted yesterday. Most techs who get jobs in outpatient surgery…” Dean shrugged. “We’ve got our own pace. Nothing wrong with that. But now that I know what makes the Doc tick, I’m gonna do my best to give him what he wants and keep him happy. And if that means being the kind of tech you’ll find in the big hospitals, then…”

“It’s not just that,” Ellen insisted. “He was downright jovial today. The only time I’ve heard him use that many words at once was when he was heaping abuse on Bobby for not keeping the patient under deep enough.”

“Don’t know what to tell you there,” Dean said, tossing his sharps container into the larger sharps collection bin. “Maybe try talking to him like a human instead of a human-shaped asshole. It worked for me.”


	6. September: Not What I Ask For

**Summary for the Chapter:**

> I

The sense of detached recognition upon returning anywhere after time away is a difficult one to shake, even if the time away has only been a week. Dean stood at the refrigerator in the break room in gentle bemusement as he attempted to draw the atmosphere of the surgery center back into him, become reacquainted with the cadences and ebbs and flows of time as it swirled around surgery schedules and coffee breaks and the inconstant pauses between cases.

“Hey, stranger,” he heard someone say, and he snapped back to the present and grinned as Jo playfully shoved him to the side so she could open the refrigerator to deposit her lunch. “I was worried you weren’t coming back.”

“I almost didn’t,” Dean replied, only half-joking. He hadn’t realized that it was possible to miss driving aimlessly for days on end. Even now, something tugged at him to just turn around and leave, looking back only to admire the cloud of dust he left behind. He shook his head to clear it of the ridiculous notion. Romanticizing the life he’d worked so hard to cast off was the worst possible way to remember it. “What’s on the schedule for today?”

“Guess.” Jo said with a wry twist to her mouth, pulling a folded schedule from her front pocket and thrusting it at Dean. “I’m really, really glad you’re back, because if I ever have to scrub for that man again I’m going to stab him in the eye. Preferably with something blunt, so that I really have to dig around with it to do some damage.”

Dean stared blankly. “Did he spit on you or something? I thought he was…you know…getting better with the whole ‘being a douche’ thing.”

“Oh, he’s a perfect gentleman with you,” Jo said, lowering her voice. “All I heard last Monday was ‘Dean does it this way’ or ‘try Dean’s way’ or ‘you should have Dean show you how he manages his ties.’ I swear he’ll be announcing his engagement to you any day now.”

“Shut up.” Dean looked down to scan the schedule. The only thing scheduled for his room was an arteriovenous fistula repair, which was scheduled to fill all the hours between the room opening and lunch. He winced.

“I mean it,” Jo pressed. “He clearly has a thing for you, and, well…I mean it’d work out, wouldn’t it? He’s gay, and you’re gay, and –”

“I’m going to stop you right there,” Dean said, feigning deep interest in the schedule so he wouldn’t have to look up. “One, I’m not gay. Just…not straight. And I’d appreciate it if you didn’t shout it to the sky in the middle of the goddamn lounge.”

“Dean, everyone already knows,” Jo began in a whisper, but Dean held his hand up.

“Everyone _thinks_  they know, and there’s a big difference between everyone thinking they know and everyone actually knowing. And that big difference includes me being able to sleep at night.” Jo looked like she was about to say something, so Dean barreled on before she could. “Two: just because we’re – we’re – let’s call it ‘preferentially compatible’ – doesn’t mean we’re the least bit interested in each other. May as well assume that you’ve got eyes for Kevin because he’s a dude.”

Jo reddened visibly at this, and Dean decided not to wonder if he’d accidentally uncovered something. “Three –”

His third reason for Jo to well and truly avoid ever bringing the subject up again was interrupted, because at that exact instant, Dr. Novak stepped into the lounge and Dean instantly felt his mouth go dry.

He had, of course, seen Dr. Novak in street clothes at the picnic nearly a month ago; the jeans and black button-up shirt had certainly done him justice in a casual sort of way. Dr. Novak was clearly dressed to receive patients – likely the lack of scheduled surgeries in the afternoon slots meant he would be holding clinic hours during that time – and the deep chocolate of his suit only emphasized the clean lines of its cut across the surgeon’s shoulders and the contrast between it and the pale blue of his dress shirt. The blue of his shirt and the darker blue of his tie did impossible things to the surgeon’s eyes, which were some new and fascinating definition of blue that put Dean at a sudden horrifying loss for words. He was acutely aware of his tattered hoodie and threadbare black jeans, as well as the fact that he didn’t think he’d done anything with his hair other than rake a sleepy hand through it before he’d gotten out of the car.

“Morning.” Dr. Novak grinned, then offered the coffee cup he held to Dean, who took it automatically before blinking hard to dispel the idiotic expression he was sure he was wearing. “Long case today. I’m going to need you on your toes.”

He was already backing out of the lounge, so Dean could possibly have completely imagined the wink just before Dr. Novak disappeared around the corner, if it hadn’t been for Jo pointedly clearing her throat.

“You were saying?” she asked, voice smug.

“Shut up,” Dean said, absently bringing the coffee to his lips.

II

“Dean Winchester, friendly neighborhood surg tech,” Dean said cheerfully. “I have all the instrumentation for this case, and the graft for the possible shunt is in the room if we need it. There’s quarter percent Marcaine with epinephrine on the field as well as heparinized saline and plain saline for irrigation. Counts have been established. Bobby?”

Bobby recited his portion of the time-out, Dean tuning it out as largely redundant. Necessary, but redundant.

“Cas Novak, surgeon” Dr. Novak said, but something in his voice caught at Dean’s attention and he peered closely at the surgeon. “We’ll be correcting a previous arteriovenous fistula, possibly with a shunt, on his left arm. This should be routine and I don’t expect any unusual blood loss. He’ll go home today. Any other concerns?”

Dean was fairly certain he wasn’t imagining it: even considering the early hour of a Monday morning, there was definitely something subdued about Dr. Novak, somehow drained of the cheer with which he’d brought Dean the coffee. He handed over the local anesthetic with a questioning expression, but Dr. Novak did not look up as he took the syringe.

The minutes flowed slowly by, the silence broken only by Dr. Novak’s murmured requests for ties, hemostats, or scissors. Once, Dean was able to catch the surgeon’s eye. He cocked his head in a wordless query, but the surgeon responded with a minute negative shake and let his eyes fall back to what he was doing.

“Sinski,” he said at one point, holding out his hand.

Dean’s brain screeched to a halt as he stared dumbly at his tray. “I don’t have any Sinskis in this set,” he said slowly. “I can get one, but –”

“Right there.” A note of impatience colored Dr. Novak’s tone, which was at least marginally better than the dead, flat timbre it had been glazed with all morning.

Dean looked at what the surgeon was pointing at and had to stifle a laugh. “Ah. That’s, uh, actually a Satinsky. Sinski’s an ophthalmic hook.”

“Whatever.” Dr. Novak waggled his fingers. “Give me what I need, not what I ask for.”

“Really?” Dean asked, pitching his voice to be very carefully teasing. “I don’t think you’re allowed to use that phrase unironically.”

Dr. Novak looked up again, and this time he did not hide the haunted shadow behind his eyes very well at all. Dean swallowed and wordlessly placed the vascular clamp into the surgeon’s hand.

Dean didn’t try to make any more jokes; the atmosphere in the room pressed against Dean’s skin with almost tangible tension.  Three hours later, skin adhesive still drying on the closed incision, Dr. Novak took his leave, slipping from the room without a word.

III

“What’s up?”

Dr. Novak looked up in surprise as Dean closed the door to the dictation room behind him.

“I appreciate that you didn’t just ask ‘What’s up, Doc,’” Dr. Novak said with a strained smile that didn’t touch his eyes.

Dean shook his head. “You can’t hide by being funny. What’s eating you?”

Dr. Novak sighed. “You’ll know sooner or later.” He toyed with the pen in his hand for a moment. “I got a voicemail this morning. One of my patients had an SSI.” Dr. Novak let his eyes drop to the pen. “She died from related complications last night.”

Dean felt his jaw drop. His mind worked at double-pace to try and compose something to say, but the best it could present was “Shit.”

“It was the case where we – where  _I_  – dropped the vein hook,” Dr. Novak continued in a flat voice.

With a horrible sour twist, Dean felt his stomach drop. A surgical site infection death in a case where an instrument had dropped… “There’s going to be an investigation.”

Dr. Novak nodded. “Infection Control will be in contact with everyone.” He swallowed. “I really hope documentation is up to scratch, because if we can’t document that the instrument was properly sterilized after the fact…”

“It was,” Dean said firmly. “And I saw the indicator. There’s no way she got anything from that. It had to have been something else.”

“Maybe.” Dr. Novak reached up to run a hand over his face. “At any rate…that’s why I’m out of sorts.”

A shiver ran down Dean’s spine as a revelation struck him. He could be wrong, but… He pulled a chair out from one of the desks, legs straddling the back of it as he rested his arms on the top of the backrest. “It’s not your fault,” he said.

The incredulous eyebrow that Dr. Novak raised confirmed Dean’s suspicions. “Are you sure about that?” the surgeon asked archly.

“Absolutely.” Dean swallowed. “I actually check indicators and filters. Every single thing you touched was sterile. I didn’t let you use the skin blade on deep dissection. I even changed hypos on the local after I drew it up.” He shook his head. “That case was as tight as we could possibly make it. It’s not your fault.”

“She was on my table,” Dr. Novak insisted. “She got the infection because she was on my table.”

“Doesn’t make it your fault,” Dean replied stubbornly. “Come on, Doc. You know this.” He caught the surgeon’s eye and held it. “If it’s anyone’s fault, it’ll be mine, for contamination that I didn’t catch.”

“My table,” Dr. Novak repeated.

“My instruments,” Dean countered. “At least wait until the investigation is done to assign blame.”

Slowly, Dr. Novak shut his eyes and then nodded. “I suppose that’s fair.”

“I mean it,” Dean said as he rose from the chair. “Don’t start beating yourself up again as soon as I leave. You don’t deserve the kind of abuse you’re capable of dishing out.” He paused. “That sounded better in my head.”

“Point taken nonetheless.” Dr. Novak offered a small smile, much more genuine than the one he’d tried earlier. “I imagine I’ll see you next week.”

“Next week,” Dean agreed.

IV

“Dean.”

Dean looked up in surprise from unlocking his car. “Doc,” he said in response. “Didn’t realize it was next week already.”

Dr. Novak shifted the shoulder strap of his satchel, swinging the car keys in his hand around a finger by the keyring. “No one else here would have done what you did today.”

For the space of several heartbeats, Dean had to frantically try to remember what he’d done that had been out of the ordinary.

“I’m – not exactly popular here,” Dr. Novak continued as Dean continued to draw up a blank, “and…I needed to hear it. Even if I didn’t know it.”

“Oh,” Dean said as his mind lit upon what the surgeon was talking about. “That’s why I did it.”

One corner of Dr. Novak’s mouth twisted in a shadow of a wry grin. “Because I needed to hear it, or because I didn’t know I needed it?”

Dean found himself reflecting the same not-quite grin. “What you need, not what you ask for, right?”

That earned him an actual halfhearted chuckle, and the sound twisted into a tiny pleasurable knot in Dean’s chest. “Right. I’ll see you next week. And…thank you.”

Dr. Novak’s footsteps echoed in the cavern of the parking garage long after he’d walked out of sight. 


	7. Interlude: Rivers of Scarlet

**Summary for the Chapter:**

> It was not true chaos.

True chaos was shots being fired, people in a panic, trampling one another and falling to be trampled themselves. Chaos was smoke and flames and a thousand shouts from a thousand throats. Chaos was roofs being ripped from houses by winds of godlike wrath.

This was just one man, draped in blue and surrounded by people swathed in blue paper gowns and white gloves, who wouldn’t stop bleeding.

Cas stood, useless, blood-soaked gloved hands folded in front of his chest as though keeping them sterile mattered.  _Disseminated intravascular coagulopathy_ , a disconnected, orderly corner of his mind supplied. An abnormal clot somewhere was using up all the clotting factors, leaving raw wound edges bleeding freely with no mechanism to stop. He watched, numb, as nurses attached bags of donor blood to IV poles, and as deep red flowed through the tubes into the patient on the table – but not as quickly as rivers of fresh, bright red seeped from the edges of the surgical wound, the endless tiny vessels in the subcutaneous fat…blood dripped from the edges of the drapes onto the white linoleum floor in tiny rivers of scarlet to pool in the cracks and indentations of years of hard use.

“Cas!” one of the surgeons barked. “Get in here and Bovie everything you see, and if it doesn’t burn, clamp it!”

The tech was handing hemostats faster than Cas could keep track of; the circulating nurse had called in two more staff who had not even donned masks in their hurry, and they were opening additional hemostats onto the field as quickly as the tech passed them off to the surgeons. 

Cas took up the electrocautery pencil and began wiping blindly with a sponge, trying to soak up the cascades of blood and see where it was coming from, and within seconds the sponge was sodden and limp in his hand, warm as the body from which the blood that soaked it had just escaped. He reached in with the pencil anyway and began cauterizing anywhere there might be a vessel in the subcutaneous fat, reasoning that there was little damage he could do there, and the most good.

“The clot’s in his left renal artery,” he heard dimly, and the words themselves made perfect sense, except that Cas couldn’t make them apply to what was on the table before him. The tone of the Bovie sounded and the smoke plumed, and he moved on to another vessel.

There were chimes and long beeps and frantic motion at his elbow, and he continued, seeking another tiny seeping vessel and cauterizing it, a man with a bucket against the incoming tide, until one of the surgeons gently took the pencil from his fingers.

“It’s done, Cas,” she said, placing it precisely in its plastic holster. “We did what we could.”

Cas looked at the man on the table before him and it slowly dawned on him that he was no longer bleeding.  
  
He was, in fact, no longer doing anything.

Stricken, he looked at the surgeon, who was collecting the suddenly useless hemostats with a detached efficiency. “Just…just like that?”

“There wasn’t anything more we could do,” she replied. She looked sadly at the body on the table. “Sometimes it happens, especially in the heart room.” She turned to him. “You’re a resident, and this sort of thing is hard to see when you’re fresh. But if this is going to be your specialty, you need to grow a thick skin. Because it will happen to you again, and it will be your table, and you will have to find a way to deal.”


	8. October: The Only One

**Notes for the Chapter:**

> I

The rain that trickled down the glass in rivulets did nothing to improve Dean’s mood. He sighed deeply and turned back to Dr. Henricksen and his damnable little voice recorder that meant Dean could let loose none of the profanity he’d dearly like to unleash.

“Yes,” he said, confirming to the doctor from Infection Control for the third time, “The vein hook was dropped. We sent it to be decontaminated and sanitized, and then we put it into the autoclave in the room. The nurse gave me the indicator along with the hook when it was done. The indicator was changed. From what I could see, the autoclave got to the temperature and pressure it should’ve, and it ran for a good ten minutes.”

“So there isn’t a doubt in your mind that the instrument was safe to use?” The man across from him looked up expectantly, and Dean felt a new wave of dislike rush through him. Dr. Henricksen was a different sort of doctor, a Ph.D. in infectious disease, and kept on staff with the medical group for the specific purpose of tracking infection rates and proposing ways to reduce them.

“If there had been, I wouldn’t have used it,” Dean said evenly. “I’m not an idiot.”

“And you are likewise sure about the supplies and instruments you opened onto the field?” Dr. Henricksen looked up from his tablet in expectation.

“Dr. Henricksen,” Dean said, leaning forward. “I know you’re just doing your job. But do I really look like a moron who doesn’t check to make sure sets are sterile, and then lies about it repeatedly during an investigation?”

“We’re just being thorough,” Dr. Henricksen began.

“You’ve been thorough three times now,” Dean interrupted. “Very thoroughly questioning whether I’m competent enough to do my goddamn job. It’s not rocket science. Are the little lines black? Is everything dry inside? We’re good to go! Hallelujah!”

“Mr. Winchester,” Dr. Henricksen said flatly, “If you don’t want to cooperate, it will affect more than just you. I strongly suggest you reign in your attitude.”

“I’ve been cooperating for two hours. Which is two hours I’m not scrubbing cases. If you wanna keep paying me to answer the same questions over and over again instead of assisting surgery, then by all means.” Dean spread his hands.

“Winchester,” Dr. Henricksen said, and Dean was glad he had dropped the obsequious “mister,” “a patient died from a case you were responsible for keeping sterile. If you don’t respect the gravity of the situation you are in –”

“I respect it,” Dean interjected. “I respected it the first time you said it, and the second time, and I respect it now. But if you keep asking me the same questions expecting different answers so you have someone to point a finger at, it’s not gonna happen.” Dean crossed his arms. “I will swear on my mother’s grave that everything we touched in that case was sterile according to every indication that I had access to, barring precognition.”

“Will you swear on Dr. Novak’s license?” Dr. Henricksen asked seriously. “Because that’s what it could come down to.”

“Absolutely,” Dean replied firmly.

Dr. Henricksen sighed heavily. “Go have lunch. Come back here at one.”

“Are you serious?” Dean asked incredulously.

“I need to meet with the team as a whole,” Dr. Henricksen replied flatly. “Believe me, if I could exclude you, I would.”

II

The second hand had been stuck for at least two minutes now, leaving the clock in the tiny conference room suspended at ten minutes to five. Dean stared at it, paying absolutely no mind to the tired, somewhat irritated words that were being exchanged between Bobby and Dr. Henricksen about the patient’s body temperature during the procedure.

“Is the clock really stuck?” Dr. Novak murmured next to Dean’s ear, leaning over so that no one else could hear. Dean caught the barest hint of his cologne and he closed his eyes to suppress the completely inappropriate urge to inhale more deeply and revel in it.

“Either that or we died, and this is hell,” Dean responded in the same low tone.

“Interesting theological concept,” Dr. Novak mused. “Hell: going over your life’s worst mistakes in meticulous detail.”

“You didn’t make any mistakes,” Dean replied automatically. “Thought we agreed you weren’t going to do that again.”

“We did,” Dr. Novak said, “but then I went home and didn’t think about anything else for three days.”

“Am I going to have to follow you around hitting you with an ‘it’s not your fault’ stick?”

Dr. Novak looked mildly taken aback, but was saved from having to respond as Dr. Henricksen cleared his throat loudly, closing his folio that lay on the table in front of him.

“The documentation is hard to argue with,” he said, “as well as your testimonies. I’ll compile my report, but from what I’ve seen, I don’t think that there is anything more this surgery center could have done to prevent this infection, aside from taking another look at the continued use of cloth caps.”

Dean bit back a retort about how they were not rubbing their heads on surgical sites, and that disposable caps would make no difference and were stupid besides. “So we’re off the hook?”

Dr. Henricksen shot Dean a long-suffering look. “Wait until the report is official, Winchester. I still need to check the biologicals on the autoclaves for all the instruments you used. One of them might be faulty. And the patient’s family could still be well within their rights to sue for misfeasance.”

“Who?” Dr. Novak asked suddenly.

“Pardon?” Dr. Henricksen asked.

“Who is the family I put into bereavement?” Dr. Novak clarified.

“Doc,” Dean said warningly under his breath. Either the surgeon didn’t hear or was pretending he hadn’t.

“As I understand it, she’s survived only by her granddaughter,” Dr. Henricksen replied.

Dr. Novak nodded, setting his jaw. “Right. Are we done here?”

He didn’t wait for an answer before standing up and pushing out of the room. Dean stared after him for a moment before sharing a glance with Ellen and following.

III

“Doc.”

“Dean.”

Dr. Novak didn’t turn; with his back to Dean, it was impossible to tell that anything was wrong. He sounded perfectly calm. The set of his shoulders was firm, controlled. Even the hands resting on the rails of the balcony were relaxed, not white-knuckled as they gripped the metal.

Dean knew better. He was well-practiced enough at hiding in plain sight to know when someone else was doing it, even if they did it well.

“You need a drink.”

It wasn’t a question, but Dr. Novak answered it anyway. “I need several.”

Dean nodded. “It’s payday. I’m buying.”

Dr. Novak’s shoulders rose and fell once as he took a deep breath. Dean waited, a vague anticipatory quiver snaking through him.

“Okay.”

IV

“Did she need the surgery?”

Dr. Novak blinked blearily at him from across the table. “What?”

Dean gestured with his empty shot glass. “In your professional opinion, as a doctor, did she need the surgery?”

“She was in constant pain,” Dr. Novak hedged.

“That isn’t what I asked.”

“She could have lived without it.” A brittle, self-loathing grin spanned Dr. Novak’s face. “Would have lived without it.”

“In constant pain,” Dean pointed out, desperately trying to steer the conversation away from where Dr. Novak was determined to drive it. “You advised her to get the surgery – which was the right thing for her.”

“I advised her granddaughter, actually,” Dr. Novak admitted. “Victoria had dementia. Her granddaughter was just trying to find a way to make her grandmother more comfortable.”

“Okay,” Dean said quickly, snapping his fingers in Dr. Novak’s face to keep him from lowering it into his hands again. “The surgery was necessary for the diagnosis. Do we agree on that?”

Mutely, Dr. Novak nodded.

“Doc, you may recall that I was there. That case went flawlessly. Everything was beautiful. And everything was  _sterile_.” Dean thumped the table, making Dr. Novak jump. “I’m damn good at what I do. If it turns out that your patient – Victoria, right? If it turns out that Victoria died because of contaminated instruments…” He shook his head. “I know I don’t have as much at stake as you. I could lick every instrument in that pan and legally it’d be on you, since surg techs don’t get licenses. But, Doc.” Dean wanted to reach out and forcibly lift Dr. Novak’s chin to prevent him from studying the wood grain of the table again. He didn’t. “You and I – we did a good job. Documentation shows that. We’ve got everything on our side except you.”

“I don’t even know her name,” Dr. Novak said in a low voice. “I took her grandmother away from her and I can’t even remember her name.”

The thick walls of the shot glass were all that saved it from shattering as Dean slammed it down on the table. “Dammit, Cas!” The rest of the bar hushed by a fraction as Dr. Novak looked up in utter surprise at the use of his name. Dean resisted the urge to swallow as the surgeon’s eyes met his. “You did the right thing, for the right reasons. Just because it went to hell doesn’t mean it turned into the wrong thing. You did the right thing, and it is not your fault that bad things happened.” Dean broke the gaze to glance in the direction of the door. “You don’t believe me, I’m not gonna stop you if you leave. But if you stay, it means you’re willing to let me convince you of that.”

The background noise of the bar had resumed its normal volume, but it seemed somehow softer around the edges, as though the only sounds that mattered were what crossed the table at their booth in the corner. Dr. Novak’s brows furrowed slightly. “Dean,” he said slowly, “why do you care?”

Dean blinked. “What?”

Gesturing at the seat Dean occupied, Dr. Novak sat up a little straighter. “Why are you here, wasting your Friday night, trying to talk me into admitting what I already logically know?” Dr. Novak let his hand fall to the table with a dull thud. “I know everything you’re telling me. I’ve been saying it to myself all week. Why are you spending your precious time repeating what I already know?”

Dean leaned forward on his elbows. “Because clearly, you’re not getting the message.” The surgeon’s eyes were a deep, clouded blue in this light, and Dean tried to force every ounce of sincerity into both his voice and his gaze. “You’re a good surgeon. Probably the best I’ve worked with. And honestly, it would kill me to sit back and watch you beat yourself up over something that, I will say again and again until you fucking  _hear_  me, is not your fault.”

Dr. Novak stared blankly for several heartbeats before his eyes slowly looked to the door. A sickening, falling sensation gripped at Dean’s chest as Dr. Novak stood and walked away from the table, the sound of his footsteps lost to the clamor of the bar around them. He didn’t turn to watch the surgeon go, opting instead to watch the reflection of the lights and action of the bar in the curve of the shot glass.

V

Two thick-walled tumblers made a crystalline  _thunk_  on the table, their amber contents splashing against the sides and clinging in a film before draining back to the bottom of the glass. Dean straightened from his reverie, startled, looking up in disbelief.

“Convince me.” Dr. Novak slid onto the bench across from Dean, thrusting one of the tumblers across the table. “Because I think you’re the only one who could, and I know you’re the only one who would.”


	9. October: Feedback Loop

**Notes for the Chapter:**

> I

The cardboard cup had no distinguishing name or logo, just generic line art and a blank cardboard sleeve. Dean stared at it before taking another sip.

Was coffee on Monday morning at work more or less friendly than whiskey on Friday after work? What did it mean? Did it mean anything at all? When was coffee just coffee?

“Damn head games,” Dean muttered, scratching the back of his neck.

Dr. Novak had delivered this cup much like he’d delivered last week’s, ducking into the lounge for just long enough to hand it to Dean before leaving with a shy smile and downcast eyes – no wink, this time, though there had been considerably more eye contact that Dean wasn’t sure what to do with. The surgeon had already donned his scrubs, leaving Dean bereft of another opportunity to see him in street clothes, a strange sentiment that left Dean wondering why he had the sudden craving to see jeans and tee shirts when he rarely cared about such things.

He’d combed his hair this morning. He’d tried to tell himself that it was for no particular reason, and that it was just a good idea to appear well-groomed for the five minutes between the car and donning a scrub cap.

Dean was not very good at lying, but he was well-accomplished at outright ignoring certain inconvenient truths.

II

Dr. Novak was literally twiddling his thumbs. Dean sighed and looked toward the door to the core. Any second now, Ellen would be back.

Behind the drape, Bobby was arguing quietly but passionately on the phone with the anesthesia charge nurse over the anesthesia of choice for the next patient; Dr. Novak’s request for aid had already fallen on deaf ears from that quarter. In Dean’s mind, he could see Ellen moving swiftly through the shelves of the core and finding the bin of crucial eschmark bands empty. They couldn’t start until they had one, and the one that Dean had let slip through his fingers and bounce across the floor would do no one any good.

“I’ll just use an ACE,” Dr. Novak said as the seconds ticked by. “Help me up with the arm.”

“There’s no one to –” Dean began to protest, but fell silent at a glance from the surgeon and hoisted up the elbow of the patient. Dr. Novak wrapped the bandage around the arm tightly, forcing the blood from it, then took the weight of the arm from Dean.

“Break scrub and turn the tourniquet on for me,” he said, nodding in the direction of the tourniquet. “Let’s do 220. And then while you’re at it, plug in my headlight.”

Dean shrugged and stood, pulling his table to within arm’s reach of the surgeon before he stripped off his gown and gloves. Turning on the tourniquet was a simple matter of pressing a button – something he could easily have done through the shield of a sterile towel without breaking his scrub – but plugging in the light source of Dr. Novak’s head lamp would, of course, be another matter entirely. If he was going to break scrub for the one, he may as well do it for the other.

“Tourniquet up,” he announced as the machine hummed, and Dr. Novak began stripping the patient’s arm of the ACE bandage.

“Thanks. Light cord is in my back pocket.”

Dean nodded as he circled behind the surgeon, parting the back of the surgeon’s gown and reaching inside, fingers following the light cord that trailed down from the back of the headlamp Dr. Novak wore. The light cord was inside the gown to prevent the unsterile cord from swinging into the surgical field; that necessitated the surgeon having to put on the unplugged headlamp before going to scrub, which meant he was reliant upon the nurse to grab the fiberoptic cord from beneath the gown and plugging it in for him. Most surgeons put the end of the cord in their back pocket to avoid having it trail behind them on the ground; fiberoptic cords were expensive and broke easily.

Dean tugged at the cord, reaching behind him with one foot to pull the light source closer.

The end of the cord stayed resolutely in Dr. Novak’s pocket.

Dean tugged harder, with the same result. “I think it’s stuck on something,” he said, unthinkingly reaching down to where the surgeon’s back pocket should be.

Abruptly and without warning, Dean was broadsided with the notion that the warmth he felt on his hand was the body heat radiating through the thin scrubs from Dr. Novak’s back. He froze, his hand hovering centimeters from the small of Dr. Novak’s back, and he found himself having to tamp down on the sudden inexplicable urge to move his hand those few centimeters and lay it there in a caress.

“Probably a stray thread,” Dr. Novak said, shifting on his stool and inadvertently crossing those few centimeters himself, pushing back against Dean’s hand. Dean withdrew it as though he’d been burned, and his mind raced to try and connect Dr. Novak’s words with what was currently at hand –

Yes. The light cord. Stuck. Dean swallowed and forced his mind away from any thoughts of skin and backs and hands as he followed the light cord down further into the back pocket of Dr. Novak’s scrubs.

The end of the cord was indeed stuck on a loop of thread within the pocket, and Dean’s tugging had managed to slip the loop of thread into one of the ridges of the plug. “Gimme a second,” he muttered, trying to manipulate the thread to unhook it, unable to ignore the flush of heat that spread from his middle up to his neck and down to –

Dean swallowed and redoubled his efforts to focus on the light cord and only the light cord, unspeakably grateful that his mask hid most of redness that was undoubtedly coloring his cheeks.

“What is going on back there?” Dr. Novak asked, twisting in his seat, catching Dean’s eye before Dean had a chance to avert his gaze.

The cascade of heat had already gained too much momentum, and the sudden eye contact made Dean’s stomach jump.  Nearly unconsciously, his tongue darted out to wet his lips in a nervous response as Dr. Novak’s expression very, very slightly changed from mild irritation to one of inquisitive surprise.

“It’s – just stuck,” Dean said, the words clumsy in his mouth. “Gimme another second and I’ll have it out.”

Dr. Novak reached over to the table and plucked a pair of scissors from Dean’s setup. “Here.” He held them out carefully, letting Dean take the scissors from his hand without touching Dr. Novak’s glove.

The scissors made short work of the offending thread; Dean finally pulled the end of the light cord from under Dr. Novak’s gown and plugged it into the light source.

“Intensity good for you?” Dean asked, dialing up the brightness.

“That’s good. Are you going to kill me in my sleep if I touch your sharps?” Dr. Novak’s hand hovered over the knife handle on Dean’s table.

“Go for it.” Dean coughed as he placed the scissors onto the dirty instrument cart, keeping his eyes on his task. “I’m gonna go rescrub.”

The faucet at the far end of the scrub sink never dispensed warm water. Dean headed straight there, tearing his mask from his face, and slammed his knee against the panel that started the flow, cupping his hands beneath the frigid water and bringing them to his cheeks.

The shock of the water against his skin knocked his mind out of its feedback loop of rapidly building lust and he stood with his hands bracing him against the sink, breathing deeply as he willed his body to calm down. Silently thanking whichever god had decreed he wear boxer-briefs today, providing him some sort of dignity where hiding his unexpected arousal was concerned, he grabbed another mask from the boxes above the sink and tied it on.

“Jesus,” he muttered to himself, closing his eyes and taking one last deep breath before he ripped open an iodine scrub brush. “Are you fucking fifteen? Get a grip.”

III

The duffel bag hit the floor with a resounding  _thunk_ , and Dean paused to take in his surroundings. The motel room was certainly cleaner than the likes of what he’d grown up in, but there was still that feeling of non-permanence, the air of transience that meant the bed made no attempt to be like home and no apologies for its lack.

Dean forgave it anyway as he sat at its edge and toed off his shoes before swinging his legs up and grabbing the television remote. He let his mind wander as he flipped aimlessly through the channels, more for something to do than in search of anything to occupy his mind.

He’d left champagne chilling in an ice bucket on the table, surrounded by the Christmas lights he’d dug from the garage. He’d considered candles for the ambient light, then immediately dismissed them – he wasn’t intending to stay home and watch them, and both he and Sam were understandably leery of house fires.

He’d also left a simple card, some gooey Hallmark nonsense, congratulating his brother and soon-to-be sister-in-law, telling them he’d cleared out for the evening to let them have some privacy in their home and to enjoy the champagne. It would all be terribly embarrassing if there was any chance of Jess declining Sam’s proposal tonight, but the chance of that seemed laughably small.

It felt strange to be on his own tonight. It struck him that this was the first night alone since he’d shown up on Sam’s doorstep that he wasn’t spending in either their spare room or his room in their house. Even during his short time living with Cassie, his room at Sam and Jess’s had still been his. He had always somehow taken for granted that they’d made a place for him, and that it would always be his.

And yet it had felt gauche to stay there tonight, when Sam and Jess would be celebrating. Sam had not asked Dean to make himself scarce; Sam would never request something like that. Just like, Dean surmised, Sam and Jess would never actually ask him to move out.

But there would be clashes. Dean knew that already. Sam and Jess were family, but they were doubtless going to be starting a family of their own before long, and while that didn’t mean Dean would not be welcome in their home…

Dean realized that he’d been staring at an infomercial for microwave pasta dishes for several minutes without seeing it. He turned the television off and kicked off his jeans. The hour was early, but he felt troubled enough that he knew sleep would be elusive for a long time.

They’d never ask him to leave. But that didn’t mean he shouldn’t start making plans to let them start their lives together. They’d been there for him in the dark months after Dad had died; they’d supported him while he went back to school. Now he had a job – a career – and it was time to turn his mind to the possibility of truly being on his own for the first time.

IV

He’d been right.

The red digital numbers of the clock gleamed at him accusingly, as though he actually wanted to still be awake at seven minutes past one. He turned over so he couldn’t see them, punching the pillow into a different shape, hoping without much conviction that the familiar ritual would allow sleep to come this time.

His mind had already raced through options for apartments and leases, deciding how and when he could pack his belongings, and figuring out how he could tell Sam and Jess about it without it sounding like an accusation or making him seem like a martyr. He’d already berated himself for the sickly tendril of fear at the prospect of being on his own, truly alone in a place that was nominally his. He didn’t have the disposition to be alone. He needed to have people, a support structure, even if it was only in the background. Even here, tonight, he felt dreadfully small in the empty motel room. He could die there and no one would know. Well, the cleaning staff would, and the surgery center would probably wonder where he’d gone, and that was comforting in a morbid sort of way.

Mind having handled these insecurities so many times that the edges had grown worn, it now turned to a new trouble that had been hiding beneath the surface, waiting for Dean to stop paying it mind. Unbidden, the image of blue eyes floated before his own, and he felt a sudden odd pressure blooming in his chest that was not entirely unpleasant.

Dr. Novak had not mentioned the moment of clarity that had passed between them with that glance; Dean had to wonder if he’d perhaps imagined it. If Dr. Novak was ignoring it, that was probably for the best as well; neither of them truly needed the complications that would arise if either of them acknowledged what had happened there.

What had happened there was a matter of some confusion that chased away any possibility of sleep. Dean sighed and rolled onto his back, studying the shadows on the ceiling.

He could blame it on being starved for touch; his last encounter that had had any sort of satisfying release had been years ago, unless he was inclined to count his near-daily interactions with his hand, and he was not. The idea of his touch being welcome to someone else – nearly anyone else – was greatly appealing, if he had the energy or the time or even the desire to go out and find someone interested in that sort of exchange.

The idea that someone might want to touch him in return seemed so alien that it could not find a place to settle and instead floated in the front of his thoughts, attaching for brief moments to snatches of images of hands that Dean could not deny belonged to Dr. Novak. Hands that curled around a tumbler of whiskey in the dim light of a bar; hands that held nondescript cardboard coffee cups; hands that lingered on his shoulder for a long beat before they’d separated on Friday night, late enough to call it Saturday morning.

Dean closed his eyes in mild embarrassment at the association of memories and desires. He must be more exhausted than he thought, if his mind was lingering on such notions. Dr. Novak had simply been a warm body close to his, and something had triggered a reaction to it. That was all. That was all he wanted it to be. That was all it  _could_  be.

Dean was not very good at lying, but he was well-accomplished at denying inconvenient truths. The clock glowed two o’clock before his mind grew weary enough of denying that it surrendered to sleep.

**Notes for the Chapter:**

> illustration by [lillilolita](lillilolita.deviantart.com)


	10. October: Dr. Novak, Are You Prepared?

**Notes for the Chapter:**

> I

“Dean!”

Dean looked up from rinsing off his hands to see Chuck bearing down on him, which was almost never a portent of anything delightful. “Yeah?” he asked carefully as he tore off a paper towel to dry his hands.

“How are you at BKAs?” the charge nurse asked.

“A BKA?” Dean whistled. “Why are we doing it here? Those usually go to St. Luke’s.”

“It is at St. Luke’s.” Chuck shrugged. “Cage is doing it, and wants Novak there for the anastomosis. And Novak wants you. You’re on the books to tech for St. Luke’s, right? You take call there?”

“Yeah.” Dean wrinkled his brow to remember if he had his badge for St. Luke’s in his bag. “When is it?”

Chuck consulted his watch. “In about two hours. You up for it?”

Dean balled up the paper towel and tossed it into the trash bin. “I can’t go disappointing Dr. Novak, now can I?”

II

Though it took getting lost three times in the twisting corridors of the hospital, fighting with the scrub dispensing machine that wouldn’t recognize his badge, and visiting two locker rooms to find an empty place to stow his bag, Dean finally tied on a mask and stepped into the orthopedic operating room at St. Luke’s.

There was a very different feeling to being in St Luke’s Hospital as opposed to Summit Outpatient Surgery Center. Though owned by the same medical group, money tended to be funneled into St Luke’s rather than Summit, and it showed: Summit was slightly behind the curve of technology and needed a thorough retrofitting, whereas St. Luke’s had recently enjoyed a complete remodel of its surgery wing, and it still gleamed with new stainless steel and unscuffed pale blue linoleum.

Dean’s eyes automatically sought out the back table as he slipped through the doors, and noted approvingly that there were two – one for the amputation, one for the anastomosis – and that the table he deemed as his had been opened, but not set up.

“You Novak’s scrub?” the masked and gowned tech at the amputation table asked.

“Yeah. Dean Winchester. I’d shake your hand, but I should probably wait until I’m scrubbed in.”

The other tech’s eyes showed that he was politely smiling at Dean’s jest. “Leo Fitz. Good to meet you. Those should be your gown and gloves – Novak told me what size you wore.”

“Did he?” Dean asked, startled. “Didn’t think he paid that much attention.”

Leo blinked. “You’re his tech, aren’t you?”

“I guess? I’ve only known the guy for –” Dean counted in his head. “– about eight weeks or so.” He shook his head. “Whatever. When are we starting?”

“You’ve got time,” Leo said wryly. “You don’t even need to scrub in until Novak starts his thing, which won’t be for at least two hours or so. Pull up a stool and enjoy the show.”

Dean did just that, settling into a corner by the autoclave and enjoying watching the bustle of someone else’s room for once. The patient was wheeled in on a gurney – also newer than the fare at Summit – and settled onto the table as the tech deftly arranged his instrumentation. Dean would never admit how impressed he was; he was fairly certain he’d need two tables to himself if he had that many instrument pans, but Leo was obviously skilled enough to make do with just the one. He watched Leo’s movements intently, privately taking notes, and didn’t notice that Dr. Novak was in the room until he spoke.

“He’s awfully rigid.”

At the sound of Dr. Novak’s voice, Dean’s attention shifted abruptly to the surgeon, who was helping position the now-sleeping patient on the table. Even behind his mask, Dean could tell that Dr. Novak was frowning.

“I noticed that,” the anesthesiologist said in a troubled tone. “Jaw’s clenched pretty tightly, too.”

At that, Dean could see Dr. Novak’s shoulders tense as the surgeon froze. “What’s the capnometry?” he asked sharply as the anesthesia machine began a discordant beep. “Did you use sux to intubate?”

“Yeah, I –” The anesthesiologist’s eyes went wide as he looked down at the patient. “ _Shit_.”

“Shit is right,” Dr. Novak said grimly. “You want me to get a line in so we can get ABG’s to confirm, or go right to Dantrolene?”

“What?” the anesthesiologist asked helplessly. Dr. Novak’s eyes narrowed; Dean looked at the anesthesiologist and when he saw how young the eyes were above the mask, recognized the problem immediately.

“Should I take over?” Dr. Novak asked, tone urgent but still somehow kind.

The anesthesiologist nodded. “And I’ll page the charge.”

“You do that.” Dr. Novak strode over to the intercom in the corner, closing the gap quickly. “What’s the code?”

“We don’t have one,” the circulating nurse said as she stripped the heated blankets and warmers from the patient’s body, leaving his skin bare to the chill air of the operating room. “It’s just ‘MH.’”

“MH, operating room seven,” Dr. Novak said into the intercom, his voice steely with forced calm. “MH, operating room seven.” He repeated it once more and then flicked the intercom off, turning to Dean. “Dean. Do you know where the ice machine is?”

Stunned by the rapidity of events, Dean could only nod.

“We need ice. Lots of it. Take a cart and some basins – Luc, your patient’s in MH crisis,” Dr. Novak said, interrupting himself as Dr. Cage burst into the room.

“Shit,” Dr. Cage said.

“That’s the general consensus,” Dr. Novak said, the last words Dean heard as he finally recalled how to command his legs and raced for a cart and basins.

The intercom call had been picked up by the hospital switchboard; the announcement was now being broadcast through the entire surgery wing by a coolly calm female voice. Dean had to steer around three people who were jogging toward room seven, one of them wheeling an unwieldy blue cart that Dean knew had to be the malignant hyperthermia rapid response cart.

The ice machine was new and efficient, but still seemed to take hours to fill the first basin. Dean could see more personnel heading with purposeful haste toward the room, and he swallowed, his heart racing. He’d heard of malignant hyperthermia, of course – any surgical pharmacology course at least touched on it – but it was tremendously rare. One of the anesthesia drugs was making the patient’s muscles contract uncontrollably, making the body temperature spike dangerously and releasing muscle cells into the bloodstream and urine. Back in the room, they probably had thirty minutes to push the drugs that would counteract it, and they needed ice to lower the body temperature before it got more dangerous.

Frustrated with the rate at which ice was being dispensed and knowing it was gravely needed, he set another basin below the funnel, jammed the handle of the cart against the panel that activated the dispenser, and strode quickly back to the room, carrying the first basin by hand.

He’d barely made it into the room before the basin was snatched from him; he had time to glimpse Dr. Novak very grimly placing a line in the patient’s left arm before he ducked out again to pace back down the hall to the ice machine.

The second basin filled, Dean watched as the machine filled two more before the light indicating the machine was empty flicked on. Four basins would have to suffice, for now. Dean hurriedly wheeled the cart back to the room and shoved open the doors with his back, dragging the cart behind him.

No fewer than four people were shaking bottles of yellow fluid, reconstituting the drug that was the only thing that could counteract malignant hyperthermia. The contents of the first basin Dean had brought had already been emptied into plastic bags that now rested atop the patient’s bare skin; someone was already filling more bags to replace the first ones as they melted. The charge anesthesiologist had taken the CRNA’s place at the head of the bed, clearly having difficulties keeping the patient’s airway open and viable as his muscles seized. Dr. Novak, moving with that same flat calm Dean had seen before, was holding his hand out for syringes of the reconstituted drug. “Dantrolene!” he barked, snapping his fingers. “Come on!”

Hearing the command in Dr. Novak’s voice made Dean’s response automatic. He stepped up to the blue cart and grabbed a bottle of the yellow powder with one hand and began drawing up sterile water in a syringe with another. “How much are we pushing?” he asked in a low voice of the nurse next to him.

“At least two thousand cc’s,” the nurse replied shortly. “Get mixing.”

There were thirty-six bottles. Dean’s grasp of mental arithmetic was abysmal, but he was fairly certain that they’d be using every one. He grabbed another.

“Pushing the second sixty cc’s now,” Dr. Novak announced as he pushed the plunger of a syringe.

“Glucose,” the charge anesthesiologist said in a sharp tone to the CRNA. “And bicarb. Has the lab come back with the ABGs yet?”

Dean focused all his attention on grabbing another bottle, injecting it with the water, shaking the bottle until all the powder had dissolved, and then drawing up every drop of the drug into the syringe before passing it off. In the strange, unreal flow of time under pressure, it seemed to take long minutes before the fluid in the bottle had fully dissolved the freeze-dried drug, and even longer to draw up all sixty cc’s into the syringe. Behind him, Dr. Novak kept up a steady chant of how many cc’s he had pushed into the patient’s IV; at the edge of his focus he could hear other numbers and vital signs being reported in identical tones of forced calm, edged with adrenaline and fear.

Dean went to grab another bottle to find them all gone. Thrown forcefully out of his focused cycle, he looked blearily at the clock, and was astonished to see that hardly twenty minutes had passed. If he’d had to go by his aching, tense muscles, he’d have bet on at least an hour.

“Thirty-fifth syringe,” Dr. Novak announced, his voice beginning to flag slightly. “How are numbers looking?”

“Still hyperkalemic,” the anesthesiologist replied, “but coming down. Body temp is hovering around normal. I think we can move him to ICU.”

Dr. Novak nodded, and Dean could see that the surgeon looked suddenly weary. “Last syringe at ten thirty-three.” As soon as the syringe was emptied he tossed it to the ground. “Someone get me a stool.”

Dean was moving before anyone else in the room seemed to hear his request. Dr. Novak sank onto the stool gratefully, reaching up to tear his mask from his face, hands shaking. With a heavy sigh of relief, he looked up at Dr. Cage. “Luc, it’s your patient. Do me a favor and take over now.”

“Right.” Dr. Cage shook his head in astonishment. “They teach surgeons that much about MH in school now?”

“Hospital I was at had three or four MH drills a year,” Dr. Novak replied. “Most people know what needs to be done, they just need someone telling them to do it.”

“Still.” Dr. Cage laid a hand on Dr. Novak’s shoulder. “That was incredible. Thanks, Cas.”

Dr. Novak dismissed the praise with a wave of his hand, but Dean could see the surgeon sitting up a little straighter. He caught Dean’s eye and offered him a tired smile. “Hey, at least I can save one patient, right?”

III

The clock on the wall was not suspended in time today, though as Dean shifted in his seat and glanced at it he would be willing to swear that it was moving more slowly than conventional clocks.

“Is Dr. Novak going to be joining us?” The lawyer’s gravelly voice was like old, scarred leather.

“We were busy at St. Luke’s earlier,” Dean answered absently. “Give him a few minutes to get down here.”

The lawyer sighed and checked his watch in an exaggerated gesture before leaning back in his seat. Dean busied himself with looking out the window at the cloudy late October sky, letting Ellen and Bobby’s conversation fade into soft edges of sound.

The door opened and Dean had to stop himself from whipping his head around to watch Dr. Novak stride in. As Dean had suspected, he was once again wearing a suit – this one a dark charcoal grey against a crisp white shirt, the tie a shifting molten silver that caught the light. Dean briefly wondered how many suits the surgeon owned.

“Sorry,” Dr. Novak said, slipping into an empty seat. “I had a patient.”

“Not to worry,” the lawyer said expansively. “Patients have to come first.”

Dr. Novak peered at the lawyer, brows knitting. “I was under the impression that this meeting would be with Infection Control.”

“Victor’s ill,” the lawyer replied shortly. “And despite the uplifting results of his investigation, the family is suing anyway. Good afternoon, gentlemen and lady. As most of you already know, the name is Fergus Crowley, from Legal. I’ll be present at any further gatherings surrounding this incident.”

“Goody,” Dean murmured under his breath. Crowley shot him a pointed look before continuing.

“I’m advising the surgery center not to settle,” he said bluntly, opening a folder in front of him. “Which means each of you are likely to be asked to appear in court for testimony, reiterating what you said during the investigation.”

“I’m sorry,” Dr. Novak interrupted, “but why aren’t we settling? The patient died.”

“Because,” Crowley said slowly, “I can get the case dismissed on the grounds of contributory negligence. Nobody owes anyone any money, nobody’s license gets tarnished.” He pulled a sheaf of paper from the folder and began passing it around. “The results of the investigation. The hospital is responsible for nothing. Your patient died of stupidity, Dr. Novak.”

“Excuse me?” the surgeon asked, the edge of his voice sharp.

“You’ll see on page seven,” Crowley said, flipping his own packet open, “that she visited the Urgent Care facility two weeks before her death, complaining of pain and fever at the groin incision. Only at the groin incision.” He looked up pointedly. “From your testimony, the instrument in question was dropped  _after_ you had finished with the groin incision, and that the incision was in fact closed and dressed  _before_  the instrument returned to the field. Am I correct?”

“Yes,” Dean said.

“The Urgent Care nurse prescribed her antibiotics and instructed her to make an appointment to return to you, Dr. Novak.” Crowley smiled thinly. “Much like her appointment with you was never scheduled, she never picked up her antibiotics from the pharmacy.”

“Why?” Dr. Novak asked.

“That much wasn’t a part of the investigation,” Crowley replied mildly. “You may also be interested to know that of all the instructions on the post-operative wound care sheet she received, she acted counter to every single one.” He held up a hand and began raising fingers as he droned off a list. “She removed her dressings that evening to take a bath. She did not replace them. She bathed daily, in hot water, with the wound exposed. She did not spend a few days off her feet, and in fact continued to go on her daily walks.”

“That makes no sense,” Dr. Novak interrupted. “I went over everything with her and with her granddaughter after the procedure.”

Crowley blinked. “And her granddaughter?” he asked sharply.

“Yes,” Dr. Novak responded, still puzzled. “Mrs. Wilson was slightly senile. Her granddaughter was her unofficial caregiver. She said that she was living with her grandmother until she could find an assisted living facility she approved of.”

“I see,” Crowley said slowly. He returned his eyes to the paper before him. “At any rate. The investigation shows very clearly that the hospital holds no liability for the severity of the infection. Nevertheless, Miss Ava Wilson, as I mentioned earlier, is still intending to sue for misfeasance.”

With a jolt that made Dean catch his breath, a small thought took root in his mind. “The granddaughter is the only family?”

“Miss Wilson is the only surviving family member, yes,” Crowley replied.

Dean licked his lips. “Mr. Crowley. Who exactly is going to benefit from this lawsuit, if we were to lose?”

The look that Crowley directed at Dean was one of puzzled arrogance. “Miss Wilson, of course.”

Dr. Novak cleared his throat, his eyes thoroughly troubled. “As I recall,” he said slowly, “Ava is a medical assistant. She ought to know better about the care of surgical wounds. And she would also be the one to pick up anything from the pharmacy for her grandmother, who doesn’t drive.”

Crowley’s face was studiously blank. “Dr. Novak,” he said slowly, “I believe I understand what you are driving at.”

“Good,” Dr. Novak said bluntly. “Because there’s no way I’m going to come out and say it.”

Clearing his throat, Crowley was the very image of restraint and aplomb, spoiled only by the eagerness behind his eyes. “I believe we are finished here,” he said, nodding to Bobby and Ellen. “Unless you have anything to add.”

Mutely, they shook their heads.

Crowley nodded. “Dr. Novak,” he said softly as Bobby and Ellen rose from their chairs, “are you prepared for the police to become involved?”

IV

The tap on his shoulder nearly made Dean jump as he spun, fingers still buttoning the front of his shirt. A strange lurch in his chest made him swallow as he met Dr. Novak’s eyes.

“I’m buying this time,” Dr. Novak said in a strained voice.

Dean glanced around the locker room to ensure it was empty. “Drinks?” he clarified with mild disbelief.

Dr. Novak nodded. “The MH crisis earlier today, we may have just uncovered a murder charge. And we could be implicated.” He raked a hand through his hair, mussing it slightly. “If you need a drink half as much as I do, we won’t even bother pouring it into glasses first.”


	11. Interlude: How The Mighty Have Fallen

**Notes for the Chapter:**

> The door opened, and recognition penetrated the numb shock that had curled around Dean’s brain like a wad of cotton. He could see that same recognition flash across Sam’s face, as well – Sam, hair a little longer and more unruly, shoulders wider, and somehow more self-assured than Dean remembered him.

“Dean?” Sam asked in disbelief. “How…what are you doing here?”

Dean took a breath. It hurt. It was incredible how everything could hurt when life dealt a blow like this. “It’s – it’s Dad. He…hasn’t been home in a few days.”

“That’s not exactly new,” Sam said, a hint of bitterness coloring his words.

Dean shook his head. That hurt, too. “No. He’s – things changed after you left. He doesn’t go off anymore. Barely leaves his chair. And he – I got home and he was just – just gone.”

Sam continued to stare. “Did you call the cops?”

Dean let out a single exhalation that could have been a laugh. “You think the cops looked that hard for him?”

As though just realizing he was keeping his brother out in the cold, Sam stepped aside to let Dean into the apartment. Dean stared blankly for a moment before taking a step inside.

It was warm, not just in temperature but in atmosphere. There was a permanence to it, a lived-in feeling that made the hair on the back of Dean’s neck prickle. It made him somehow edgy, like a caged animal.

“Why did you come?” Sam asked as he shut the front door. “Why not just call?”

Dean spun in place. Maybe Sam was joking – but no. Genuine puzzlement shone honestly on his face. “You’re family,” Dean managed. “All I’ve got left.”

Sam opened his mouth as though to say something, then closed it in irritation as he took a deep breath through his nose. “Dean, we – we haven’t even spoken in, like, four years. I don’t even want to know what you’ve been doing all this time, but – I don’t want a part of it.”

The numbness should have been a barrier to the fresh wave of pain those words wrought, but Dean was quickly discovering that his comforting world of ‘should haves’ was dissipating around him like a castle of sand beset by the surf. “Dad’s probably dead,” he said pointedly.

“He’s been dead for a while, to me,” Sam said forcefully. “And – and you, too.” He gestured. “This – this is me, and my life, and whatever you’ve been doing with yourself since I left doesn’t belong here. Okay?”

“Sammy,” Dean began, but Sam shook his head.

“Sammy is a chubby twelve-year-old who didn’t have the sense to try and get out of a bad situation,” he said mercilessly. 

“Sammy is my brother,” Dean shot back, “who I haven’t seen for four years and is the only thing I have left because our father is  _gone_  and let me be honest with you: I’m not handling it very well.”

Sam looked taken aback, jaw slack as he locked eyes with Dean. Dean grit his teeth and let the seconds crawl past until movement at the corner of his eye made him whip his head around.

“Jess,” Sam said, gesturing helplessly to Dean. “This is my brother, Dean.” He glanced back at Dean, four years’ worth of peace offering in his eyes. “He’s…going to be staying with us for a little while.”


	12. November: Sazeracs, Pretzels, and Someone to Listen

**Notes for the Chapter:**

> I

The ordinary tumult of the locker room at quitting time did little to penetrate Dean’s trance as he sat on the bench, eyes closed, going over which muscles hurt and which ones merely ached. Dr. Cage’s ortho cases always pushed for everything Dean had, but he’d never had to act as both tech and assistant before; a human leg weighed much more than he expected, especially after holding it up for an entire hour.

He was considering a shower, a long, hot one, more for stress relief than to get clean, when his phone buzzed in his pocket. Slowly – apparently pulling-cell-phone-from-pocket muscles were the same as holding-legs-for-hours muscles – he reached for his phone and thumbed it on.

_Case dismissed. Contributory negligence. Drinks?_

The number was still not input into his phone, but the numerous other messages that preceded this one left him no doubt as to whom the number belonged.

_Sure. The usual spot?_

_See you in 30._

Dean could not suppress the butterflies that rose in his stomach; it was entirely possible that at this point they were armed, and the normal means of subduing them would no longer do.

Though there had been no repeat of the utter loss of control that had seized Dean weeks ago, he’d often found his mind wandering as he watched Dr. Novak’s fingers deftly knot suture, his eyes occasionally flickering upwards to watch the surgeon’s expression of concentration. The surgeon had caught him watching only once; Dean had looked elsewhere so quickly that he dizzied himself, and Dr. Novak had said nothing.

Even Dean’s keen powers of denial were not enough to counter the way he hung on every word the surgeon said, whether from behind a mask or over a glass, or the way his face echoed every small grin or shy smile. Coffee on Monday mornings were a ritual now, a dance of avoided eye contact, and Dean found himself irrationally wanting to keep the cups and discover where they came from, piece together another elusive detail of Dr. Novak’s life outside of the operating room.

He’d idly calculated one night while sleep circled him tauntingly: he’d spent just shy of a hundred hours with Dr. Novak. Drinks on Fridays had become almost routine, though they ceased being edged with the frantic need to dampen the smoldering edges of crisis. They’d never stayed out as late as the first time; often a single beer and a bowl of pretzels were all they shared before parting ways. Their conversations never delved too deeply into personal matters. When one talked, the other listened attentively, but often while studying the twist of a pretzel or label of a beer bottle. Dean had a feeling that both of them knew how dangerous it would be for them to lock eyes for too long.

Dangerous because Dr. Novak, Dean was sure, felt something ineffable as well, and looking into his eyes for too long might tell Dean exactly how deep it went.

They wouldn’t speak of it. They couldn’t. But they could drink beer and eat pretzels and pretend that nothing was amiss.

II

Either the surgeon had not held clinic hours today or he had changed into something more casual before reserving their usual corner booth. Dean slid onto the bench with a wide grin.

“Hey. Case dismissed? When did you hear that?”

“About thirty minutes ago, actually,” Dr. Novak replied. “I texted you as soon as I heard.”

“So what about the…” Dean lowered his voice; the bar was nearly empty, the hour still early, but it seemed like something he shouldn’t say too loudly. “The murder thing?”

Dr. Novak shook his head grimly. “I haven’t heard anything about that.” He grimaced. “I doubt any news out of that quarter will be half as good. Now that there’s an official ruling of contributory negligence…” He shrugged. “Let’s not think about it tonight.” He smiled through the worry lines at the edge of his eyes. “Let’s celebrate the fact that you were right.”

“I will always drink to that,” Dean replied, grinning. “What are we drinking?”

“Are you willing to be surprised?” Dr. Novak asked, a sly smile crossing his face.

“…Sure?” Dean replied, bemused.

Dr. Novak winked as he shuffled off the bench across from Dean and strode toward the bar.

Curiosity piqued, Dean bowed his head to listen to the exchange; it was Lily at the bar tonight, and he picked out her voice as she responded to Dr. Novak’s quiet request.

“Sure thing. Starting a tab?”

“Yes, please.”

There was the sound of glassware placed on a surface and a bottle being removed from a shelf.

“So, your friend over there…” Lily lowered her voice and Dean couldn’t quite catch what she asked, but whatever it was made Dr. Novak cough.

“I, um…I’ll ask him…but I wouldn’t get your hopes up. I’m pretty sure he’s gay.”

Dean’s eyebrows shot up and he nearly turned in the direction of the bar.

“Ah.” Lily did not sound overly disappointed; rather, she sounded amused. “Good on you, then.”

“What?” Dr. Novak’s voice sounded almost choked. “No, no, it’s not – we’re not – we work together.”

“Man, zero for two.” Lily was laughing at herself now, a self-deprecating wistful sound backed by the clatter of ice and liquid in a shaker. “I should shut my mouth before I really taste foot. Here you go. I’ll bring you some waters later.”

Dean feigned fascination in his phone as Dr. Novak returned to the table, hoping the dim lights would hide the burning tips of his ears.

“And here we are.” Dr. Novak slid a tumbler of a cloudy concoction over to him with an expectant air. Dean lifted it and immediately blinked hard as his eyes started to water.

“Whoa. And what is this?” Dean sniffed it hesitantly; there was whiskey of some sort in there, but it was clearly mixed with something else that was impossible to place.

“It’s called a sazerac,” Dr. Novak said, settling on his bench. “Rye whiskey, bitters, a bit of absinthe.”

“Absinthe,” Dean repeated, looking into the glass dubiously.

“Just try it,” Dr. Novak cajoled, and because Dean was far past the point of refusing any of Dr. Novak’s requests, he brought the tumbler to his lips and took a wary sip.

Flavor roared on his tongue like a captive thunderclap, and though he’d been raised on the worst sort of cheap whiskey, he couldn’t suppress the shiver of strong liquor as he swallowed, only barely avoiding coughing. “It’s a drink,” he managed weakly, wiping at the corner of an eye. “And I’m surprised.”

“It’s a bit unique,” Dr. Novak said, sipping calmly at his.

“‘Swill’ is the word I think I’m searching for,” Dean said, blinking hard. “Jesus. I’ve had some rough stuff, but this takes the cake.”

“Should I take that to mean you won’t be finishing yours?” Dr. Novak did not sound disappointed as he gestured to Dean’s tumbler.

“Be my guest.” Dean pushed it across the table. “Enjoy your paint thinner. I’ll go up and get something a human can drink.”

“Wait,” Dr. Novak said, grabbing at Dean’s forearm before Dean rose from the bench. The touch lasted less than a second, but the feel of Dr. Novak’s bare hand against the skin of Dean’s arm made Dean’s world lurch. “I…” Dr. Novak looked suddenly bashful. “I get the feeling you’re not interested,” he said slowly, “but our bartender has expressed interest in your marital status.”

Dean glanced over at the bar and licked his lips. “She’s a bit… _she_  for my tastes, Doc.”

“I figured,” Dr. Novak replied quickly, “But, well…you said ‘complicated,’ and there’s an entire spectrum of ‘complicated,’ so…” He lifted his tumbler to his lips and took a long sip; Dean was astonished to see a faint flush bloom in his cheeks.

“Oh, it’s complicated,” Dean replied absently as he looked away, lest he make any sort of lingering eye contact. He cleared his throat. “You want anything while I’m up there?”

“Just water, thanks.”

III

Dean drew his finger through one of the rings of condensation on the tabletop before taking a breath. “It probably wouldn’t be nearly as complicated if my mom had raised us, instead of my dad,” he said carefully, lifting his eyes to gauge the reaction this statement had on the surgeon.

Dr. Novak lowered his drink to the table with a quiet clink. “Oh?” he responded with eager politeness, as though they were continuing a conversation that had been interrupted only a few minutes ago, as opposed to two hours ago.

Dean nodded. “Mom died in a house fire when Sam and I were kids. Real young. Dad went a bit…” Dean laughed at himself bitterly, raising his beer to his lips. “A bit. Right. He completely fucking lost it. Really, we lost both parents that night, and were raised by a ghost of the man who’d been our dad.”

Dr. Novak didn’t interrupt him; Dean could see that the world had started to grow very slightly soft around the edges, and knew it was the alcohol that had loosened his tongue, but he wanted very dearly to be understood. “Sam saw through all the bullshit – Sammy’s always been smarter than me. He got out as soon as he could. But I – I just wanted the man to approve of me. I wanted to impress him. And I was – I was already never good enough. He wanted a manly, rugged, masculine brute of a son. He got me and Sammy instead.” Dean looked down at himself. “Sammy clearly wasn’t going to cut it, but I…” He shook his head and took another long drink. “I was too pretty by half to be rugged, but I could be those other things.”

“I think I see where this is going,” Dr. Novak said quietly.

“It doesn’t take a genius,” Dean replied. “I think Dad nearly did a dance when I started…getting into trouble with girls. He started actually acting proud of me. And…I mean, sixteen, man, given enough friction and time something’s going to happen and you’re going to like it.” He swallowed, his stomach feeling sour for reasons completely unrelated to drink. “And so I figured that if I liked it, that I could just…do that and be normal. And maybe Dad would stop resenting me.”

“I’m beginning to dislike your father,” Dr. Novak said.

“He kept a roof over our heads. He made sure we didn’t starve. And he made damn sure that neither of us ever got tangled in whatever he was doing to earn money. He tried.” Dean downed the last of his pint of beer and wondered where it had all gone. “For all that, he shouldn’t have been a father.”

“And what does he think of the life you’re leading now?” The question was carefully phrased. Dean shook his head and laughed ruefully.

“That’s the kicker. He’s gone. Disappeared one day without a trace. I told the cops, but they never look that hard for people like Dad. At that point we were all but homeless, trading labor for a room at the shittiest motel you’ve ever seen, spending every cent I brought home on booze and food, and…” Dean shook his head and grabbed at his empty glass before remembering it was empty. Dr. Novak slid his mostly full glass of water over and Dean grasped at it gratefully. It wasn’t the alcohol he wanted; it was the way to insert a pause, to fill his mouth with something to wash away the bitter words. “If he could see me now, he’d probably be disappointed as fuck,” he admitted quietly. “He wouldn’t see the job or – or any of it. He’d see me living with my little brother – who he disowned – and close enough to gay to make no difference in his eyes. And you know what?”

“It still hurts?” Dr. Novak asked shrewdly.

“Fuck yes, it does.” Dean shook his head. “And it shouldn’t. I like who I am. I’ve got a kickass job, and a bed that doesn’t have creepy motel stains, and – and someday I might actually, possibly, find a guy.” His glass of water was suddenly fascinating beyond comprehension as the words he’d just said penetrated his dulled thoughts. “I mean, I’m not the mess I was, and even then, I had someone who wanted to marry me,” he said, no longer certain he was making sense. “I didn’t – get married, I mean. I liked her. Probably loved her, a bit. More than a bit. A lot. But that would have been a huge mistake, and I’m done making huge mistakes.” Dean gestured expansively and managed to knock over the glass of water; ice cubes skittered across the table to land on the floor. “Shit.”

“I’ve got it.” From nowhere, Dr. Novak produced a stack of napkins and began mopping up the mess. Dean watched numbly, the downy haze of alcohol clouding up the edges of his thoughts just enough for him to know that if he was drinking anything else tonight, it’d be water.

Water that Dr. Novak brought back to the table along with another stack of paper towels, drying a place at the corner of the table with his elbow before thunking down the glasses and going to work on the wet smears across the rest of the surface. “Drink that,” he said, almost sternly, and Dean nodded obediently. He’d downed an entire glass before the surgeon finished mopping the table, clumping the paper towels and napkins into a small sodden heap in the middle of the empty pretzel bowl.

The ice water provided at least the illusion of impending sobriety, and Dean’s mind sluggishly replayed the ramble he’d just embarked upon with a sense of mortification. “Sorry,” he muttered, focusing on the light reflecting off the rim of the glass. “I just – Sammy’s heard it all before, but I…don’t talk about it to people.”

“Nothing to forgive.” Dr. Novak snapped his fingers and Dean tore his eyes from the rim of the glass to meet the surgeon’s. He’d been intending only to glance up for a moment, but the utter sincerity on Dr. Novak’s face made his conviction vanish and his gaze locked with Dr. Novak’s. “If you ever need someone to listen without judging or dismissing you…” Dr. Novak looked down, breaking the spell. “My background isn’t anything like yours. My entire life has been met with nothing but mild tolerance. But…” He trailed off.

With a boldness that astonished Dean, he reached out to tap the back of Dr. Novak’s hand. “Thanks,” he said clumsily as the surgeon looked up. “That’s…more than I’ve ever had before. From anyone.”

Almost, a threshold broke. Neither of them looked down or to the side, and Dean was sure his entire body was shaking with the pounding of his heart, and their hands lay so close together on the table top that it would be the simplest thing in the world for one of them to cross that line and grab the other.

“It’s late,” he found himself saying, and they both used the phrase as an excuse to pull their phones from their pockets and look at the clock, muttering useless phrases about how long a week it had been and sleeping.

After all, the pretzels had been gone for some time.


	13. November: Thank your Lucky Stars

**Notes for the Chapter:**

> I

Dean paid only cursory attention to the speedometer as he tore down the freeway toward St. Luke’s. While it wasn’t precisely an emergency, minutes still counted; if someone needed a AAA badly enough to require one on Thanksgiving, it wouldn’t wait long.

He’d been taking call at St. Luke’s on holidays for at least two years, enjoying the notion of being paid to sit around and actively not work. He’d rarely been made useful. When his phone had rung fifteen minutes ago, he’d assumed it was Sam or Jess, calling from Jess’s parents’ place in Kentucky to wish him a happy Turkey Day and a heartfelt “wish you were here.”

His phone buzzed on the seat next to him. Dean thumbed it to speakerphone, one eye on the road. “This is Dean.”

“Dean, this is the charge nurse at St. Luke’s. What’s your ETA?”

“I’m about a mile away from the exit,” he replied. “Five minutes once I’m off the freeway.”

“You’ll be in OR four. The PA is already opening your table. We’ll see you soon.”

“See you soon,” Dean repeated, flipping on the turn indicator for the exit.

He did not get lost this time, and as he pulled on his scrubs he tried to break down the steps of a AAA. He’d scrubbed one, a very long time ago, and the cardiovascular surgeon had been so fast that it was all Dean could do to keep up, let alone take time to soak in the procedure. “This is where my ability to bullshit my way outta anything comes in handy,” he muttered to himself, tying his cap at the nape of his neck. “Let’s do this.”

II

The back table was not nearly as chaotic as Dean had feared. Often when a tech opened supplies they would pile everything in the middle, which meant it would take precious minutes to make sense of the mess while setting up the case. Dean’s preceptor had droned on and on about opening supplies where they made sense, so that setup didn’t take as long; Dean had taken it to heart, and it appeared that whoever had opened this table was of a like mind with her.

In fact, Dean realized, as his eyes were drawn to the tidy stack of gowns at the lower left-hand corner of the table, it looked remarkably like what Cassie’s tables had looked like when she opened.

The door to the inner core opened and Dean knew who would be walking through before he could even see her.

“Cassie,” he said in greeting, resisting the urge to swallow hard against the sudden lump in his throat.

To her credit, Cassie did not stare or freeze. She moved swiftly to the table and opened the packs of suture she carried, each one landing precisely where she intended it. “Is this going to be a problem?” she asked briskly when she was done.

“You’re the PA?” Dean asked in counter to her question.

“I am.” She turned. Her eyes were cool above her mask, but Dean knew her well enough to see the tightness at the edges.

“Congratulations.” Dean nodded, raising a hand to scratch self-consciously at the back of his neck. “I’d heard you went back to school, but…no. It’s not going to be a problem. Unless it is for you.”

“That was a long time ago,” Cassie replied, her tone still distant. “And we’ve got work to do. You ready to scrub in?”

“Ready as ever.” Dean surveyed the table to ensure his gloves were there. “Who’s the surgeon?”

“New guy. Name’s Novak. I hear he’s good.”

Dean couldn’t help it; he coughed in surprise. “He is. I’ve been working with him at Summit.” His voice felt oddly strained. “I didn’t know he was here, too.”

“He’s the CVPV guy on call, apparently.” Cassie jerked her head towards the table. “It’s not going to set up itself. Let’s see if you’ve still got the moves, Grasshopper.”

“Them’s fighting words.” Dean flashed a smile that he hoped touched his eyes, where she could see it, before pushing out the doors and standing by the scrub sinks, staring at the boxes of scrub brushes without seeing them.

“Do the goddamn job,” he said to himself, his breath fogging up his safety glasses. He pinched the bridge of his nose, molding the mask there more firmly to keep the moisture from building inside the glasses and making it impossible to see. “Be an adult and do what you came here to do.”

He’d come here to scrub a AAA. The presence of a former lover and a man he painfully wished could claim that title wasn’t going to stop him.

Probably.

III

“ _Dean?_ ”

Dean spun at the sound of Dr. Novak’s astonished voice. “Hey, Doc. Fancy meeting you here.”

“Oh, thank God it’s you,” Dr. Novak said, and Dean could swear the surgeon practically slumped in relief.

“Thank your lucky stars I decided to take call this Thanksgiving,” Dean said, face growing warm at the praise. “I could have been in Kentucky.”

“And if you were, I don’t know what I’d do.” Dr. Novak stuck out a hand. “You want to turn?”

Dean looked down at his front; he still hadn’t completed tying his gown. “Yeah. Thanks.” He grabbed the card that allowed the surgeon to bring the tie around Dean’s back without touching the strings themselves and handed it off, half-spinning to grab the string on the other side as Dr. Novak yanked the card off. “Your PA is around here somewhere.” That odd constrictive feeling clutched at his chest again. “I’ve worked with her before. She used to be my preceptor. You’re in good hands.”

“Well, that’s good to hear.” Dr. Novak rubbed his eyes. “The patient was scheduled for an elective triple-A on Monday. He started acutely dissecting about three hours ago, and in the consult with his usual doctor we decided not to take the chance of waiting. You ready for this?”

“We’re gonna rock this, Doc,” Dean said confidently, eyes scanning his instruments. “Bring it on.”

IV

A trickle of sweat crawled its way down its path between Dean’s shoulder blades, and he rolled his shoulders to try and either dislodge it or soak it up with his undershirt. He’d forgotten that open cavity cases like this often meant the room temperature would be raised to keep the patient at a safe temperature; had he remembered, he’d have ditched the undershirt.

The nurse in the room – Dean had asked his name and then promptly forgotten it – opened another package of sponges onto his table, and Dean absently shook the wad of cotton, fanning them out so each individual sponge was easy to see. “One-two-three-four-five,” he rattled off, breaking off the paper band that held them together with one hand while handing Dr. Novak a retractor with the other.

Time was lurching by in uneven dollops. There had been a flurry of activity as the incision was made, a giant midline gash with a twenty blade, done so casually that it made Dean’s stomach do an odd jump. He was used to those hands making small, precise incisions, mindful of the surface anatomy of veins and arteries and nerves that ran close to the skin on the arms and legs. The incision had bulged outward and Dr. Novak and Cassie both had gone to work with the electrocautery pencils, controlling the bleeding they’d caused before continuing to dissect deeper at a rather alarming pace.

Now, an hour after the initial incision, Dr. Novak had mobilized the organs that obscured his view of the artery and Dean had a few seconds of breathing room as the surgeon considered his next move. “Deep knife, on a long handle,” he said finally, and to Cassie, “ease up on that retractor for now.”

“You’d be able to see a lot better if you packed the bowel out on the field,” Cassie suggested.

“I don’t  _want_  to pack the bowel out on the field,” Dr. Novak replied sharply. “I can get in underneath it. The aneurysm is high enough that I can just use a tubular graft, and those are much simpler to put in.”

“How are you going to anastomose with the bowel in the way?” Cassie pressed.

“It’s not  _in_  the way, because you’re going to retract it  _out_  of the way,” Dr. Novak replied with a tone of exaggerated patience that underlined his extreme lack of it. He shot a look at Dean. “If she was your preceptor, I see where you get it from.”

Dean suppressed a snort as he handed over the long knife handle. Dr. Novak took it, glancing for a moment over his loupes at Dean with a tiny shadow of mirth in his eyes before turning back to the patient.

“Can I get some airplane on the bed, toward Cassie? And up.”

“Airplane and up,” the anesthesiologist repeated, and the operating table began to shift, angling toward Cassie and rising up.

“Good.” Dr. Novak bent slightly, tapped on the retractor to let Cassie know to use tension on it again, and carefully reached in with the blade.

“I see it,” he said a moment later. “Sharp back. Clamps. Big ones.”

“Doctor,” Cassie said, and Dean recognized her stubborn tone, “I really think you’d be able to see better if we packed the bowel out onto the field.”

“Would you like to do this?” Dr. Novak asked pointedly, hand still held out for the clamp that Dean passed silently. “Because if you’d like to switch places I will gladly pack the bowel out so you can see. We could take the liver, too, if you wanted. It’s even more in the way than the bowel. Or maybe you could just trust that I can see everything that I need to see, and retract like I’m asking you to.” He reached in with the clamp and locked it with perhaps slightly more force than necessary.

“Is he always like this?” Cassie demanded of Dean.

For a very short moment, Dean considered a joking response, but a glance at the way Dr. Novak’s shoulders tensed told him that a joke would be the worst possible idea right now, as would telling the truth. “Another clamp for you, Doc,” he said instead, holding the second aortic clamp at the ready, shooting a very firm glance at Cassie.

Cassie seemed to get the message, and if she didn’t, she at least didn’t want to kindle any drama while a patient lay open on the table. She drew back a little more on the retractor, clearly determined to give Dr. Novak the best visual possible, even if it wasn’t her way.

“Fifteen on a long handle,” Dr. Novak said, “and is the graft ready?”

“Graft is ready,” Dean said, pulling it closer to him on the table.

Dr. Novak held out his hand, and Dean recognized the surgeon’s idiomatic sign language for “forceps.” He handed over a pair, along with the requested knife, and stood by with a basin to collect the portions of the dissected artery that the surgeon would be removing.

“Send that as specimen,” Dr. Novak said distractedly as he handed back the long-handled knife, “posterior mesenteric endarterectomy. Formalin is fine. Dean, the graft and six-oh Prolene, please.”

Dean eyed the tiny space through which he could see where the aneurysm had been. “Doc,” he said slowly, “Don’t hate me, but…are you really going to suture with these tiny-ass needles through a window the size of my asshole?”

Dr. Novak looked at the surgical site, and then very pointedly back at Dean. “Your asshole?”

“I exaggerate,” Dean amended, and he could feel his cheeks begin to grow warm. “But…Doc, Cassie’s right. You don’t have the visual there. And my long-handled needle drivers are all for giant needles, not your flimsy little vascular ones.”

“You know,” Dr. Novak said, and the tone of his voice made it perfectly clear that Dean had just blown it. “For once during this case, it’d be nice to not have someone doubting my judgment. Believe it or not, this is not my first triple-A, and this guy’s anatomy is not so dense that I can’t navigate a needle driver –”

“Doc,” Dean interrupted. Dr. Novak’s eyebrows shot up, but Dean pressed on. “You’re doing it again. Take a breath. Your judgment is awesome. We’re just saying – it’d be easy to pack out the bowel, it’d make things easy on you too, and then we can close and all go pretend we have a turkey to eat. We’re here to make it easy for you. Not second-guess you.”

“Don’t use your placating bullshit on me,” Dr. Novak muttered, turning back to the patient. He stared down for several moments, then heaved a sigh. “Fine. You want to pack out the bowel? We’ll pack out the bowel. Moist laps. A shitton of them.  _Warm_  moist laps; I don’t want to give this guy hypothermia on top of eviscerating him. Cassie, here’s your moment to shine. You pack that bowel like you’ve never done before.”

Cassie shared a significant glance with Dean as she carefully mobilized the bowel, easing it out onto the drapes and cushioning it with the damp sponges Dean handed her. Dr. Novak watched the proceeding with an impatient air, going so far as to turn to Dean’s table and begin loading his suture onto a needle driver himself. Dean clenched his jaw and decided to let it slide.

The uncomfortable tension built in the silence as Dr. Novak sewed the graft in place, until finally he huffed another sigh. “Dammit. Dean, I hate it when you’re right.”

“Keeps me up at night,” Dean replied glibly as he held out a pair of suture scissors and sprinkled some heparinized saline onto the surgeon’s fingers to make tying the polypropylene suture easier.  

“Shut up,” Dr. Novak said grumpily, but there was enough of a playful edge to it to make the corner of Dean’s mouth curve into a faint smile.

V

The final button had finally been fumbled through its hole when a hand landed on Dean’s shoulder. Dean started, twisting, not certain why he was surprised to see Dr. Novak standing there in what was apparently a hastily donned tee shirt and jeans, a long tan overcoat draped over one arm.

“Hey,” Dean said, mouth drying rapidly. “You heading home?”

“No,” Dr. Novak said, holding up his thumb and forefinger a few inches apart. “I have that much paperwork to do for this case before I go anywhere.”

“Ah.” Dean found that he was rubbing the back of his neck self-consciously, and he let his hand fall. “Drinks after?” he asked, wishing he could wince at how hopeful his voice sounded. “There’s gotta be someplace open.”

Dr. Novak shook his head, an expression of genuine regret creasing his brow. “I have a flight at eleven tonight. If I do nothing but documentation until I have to leave, I just might finish it in time to enjoy my week at home.”

“At – oh. Family?” Dean asked.

Dr. Novak nodded. “Every few years we all make an effort to try to visit all at the same time. There are five of us kids – everyone else has a family, so it makes things a little hairy. I usually let them make the plans and then show up. My schedule’s the least convoluted.” He smiled a little wistfully. “No in-laws to swap holidays with, no kids to match up school vacations.”

“Right.” Dean tugged on his jacket. “So you won’t be around on Monday.”

“No. The Monday after is a busy day, though – lots of people getting in before the end of the year.” Dr. Novak offered a shy sort of smile. “Take a week off from my needy demands and be fresh.”

Dean forced a grin to his face. “I’ll do that.” He held out a hand; slightly bewildered, Dr. Novak reached out to grasp it, not in a handshake but in a solid grip. “Have a good flight.”

“I’ll try,” Dr. Novak replied. He let go and turned to leave the locker room. Dean let his hand drop to his side and had leaned down to grab his duffel bag when Dr. Novak coughed.

“I – Dean. I can’t say how relieved I was to see you here today. It made everything go much more smoothly.”

Dean let out a small exhalation of pleased, slightly embarrassed laughter. “That’s what a good tech does.”

“No. It’s what  _you_  do.” Dr. Novak shook his head and took a half-step closer. “I’ve had good techs. But you…you keep me centered. Grounded.”

Words fled Dean’s mind. “Thanks,” he managed to force out, along with an absurd half-wave that Dr. Novak matched before he turned once more.

The door closing echoed through the empty locker room, and Dean sank down onto a bench to try and still the tumult of thoughts and emotions that demanded to be examined, not least the yawning disappointment that he’d seen the last of Dr. Novak for several days.

VI

“Dean.”

Dean looked up from his keys in surprise, watching as Cassie sidled up to his car. She smiled as her eyes followed its lines. “Still driving this old thing, huh?”

“Don’t you talk to her like that,” Dean said, patting the roof. “She’s as much of a lady as you are.”

“I’ll be sure to tender a formal apology,” Cassie replied wryly.

Silence twined between them for a few heartbeats before Dean cleared his throat. “So how long you been a PA?”

“About a year now?” Cassie’s brow wrinkled in thought. “Went back to school right after we – right after I quit Summit.” She dropped her gaze to the concrete of the ground for a moment before looking back up, eyes determined. “Look. I’m not going to waste my time with small talk. What you said earlier – go home and pretend we have turkey to eat. You living alone now?”

Dean shook his head, lips pressed firmly together. “Still with Jess and my brother. They’re visiting her parents – they just got engaged.”

Cassie nodded thoughtfully. “Always figured they would.” She took a breath, some of the conviction fading from her face. “I –” She shook her head. “I’ve got a six-pack and a turkey pot pie at home that could feed two. And I could use some company.”

Dean felt something twist inside his stomach. “Cassie –”

She held up a hand. “I know. And I get it. But…that was a long time ago. And you said that maybe someday we could be friends again.” She looked at him expectantly. “I figure now is as good a time as any to try.”

He shouldn’t. He knew her better than he knew anyone except, perhaps, Sam, and there was no scenario in which this would end well for either of them.

“I should mention the turkey pot pie is homemade.”

“I shouldn’t,” Dean began.

“Why?” Cassie asked bluntly.

“Because I  _know_  you,” Dean replied just as bluntly. “And I very clearly remember the first time I came over. First we’ll have enough beer to get tingly and buzzed, then you’ll want to watch a movie on the couch, then you’ll be cold and you’ll get a blanket and want to snuggle up, and then…” Dean shook his head.

Cassie did not bat an eye. “So are you coming?”

Dean closed his eyes for the space of a slow breath. “You still live at Parks Hill?”


	14. November: Melancholic Nostalgia

**Notes for the Chapter:**

> I

This was familiar.

The plates were new; they were heavier than what she’d had before, and Dean was glad for the TV trays that they pulled up to the couch, as holding his plate one-handed would have proved to be tiring after too long. But everything else – the microfiber of the couch, the faint smell of books and eucalyptus, the shadows cast on the walls by the lamps – stirred something close to an ache in Dean’s chest.

He tried to focus on the food, or on Cassie’s words, on anything but the fact that he was back here, and that the melancholic nostalgia threatened to draw him under like quicksand.

“And so he throws the syringe at me,” Cassie said, miming throwing her fork. “Like it’s my fault it broke?”

“Dr. Novak once threw a blood clot at me,” Dean said reflectively, shoveling a forkful of pastry crust into his mouth.

“A blood clot?” Cassie asked in amused disbelief.

Dean nodded. “A small one,” he said around his mouthful, before chewing hastily and swallowing. “It was a difficult case, and he’d finally gotten to the endarterectomy part, and I wasn’t ready with the basin, and so…” Dean shrugged. “I’m sure he didn’t mean for it to land on my face. Blood clots are notoriously hard to aim.”

Cassie shook her head. “He’s horrible. I don’t know why you put up with him.”

“Hey.” Dean let his fork clatter to his plate. “He’s not horrible. He’s just – he’s high-strung. Outside the OR, he’s probably the nicest guy I’ve ever met.”

“I’ll take your word for it,” Cassie dismissed. “Thank God you’re in love with him, because I doubt he’d ever find anyone else.”

Dean froze, a flash of something like electricity shooting through to the ends of his fingers. “What?” He asked, trying to sound casual.

Cassie rolled her eyes. “Please. I didn’t have anything to do but hold that freaking bowel out of the way. I saw the way you were looking at him.” She smirked and looked down at her plate. “I know that look. You used to look at me like that.”

Dean’s tongue was sticking to the roof of his mouth; he took a long swig from his bottle of beer just to work enough moisture back into it to swallow. “It’s a – don’t bring the L word into this,” he said finally, surprising himself by not denying what she was saying.

Cassie’s eyes widened slightly. “You mean you’re not already –”

“No!” Dean interrupted forcefully. “He’s – I’m his tech. And since that whole snafu when HR found out you and I were dating –”

“Dean,” Cassie interrupted, holding up a hand, “as fantastic an excuse as it makes, HR didn’t get pissed that we were dating. They got pissed because they thought you were sleeping with me to get the job.”

“It doesn’t matter,” Dean interjected.

“You bet your ass it matters,” Cassie countered. “He doesn’t have any say in your hiring decisions like I did. He doesn’t even have any input in your yearly reviews like I did. You are so far in the clear that the only reason you’re not already riding that –”

“He’s a surgeon!” Dean blurted, only partly to stop her from completing her sentence.

“So?”

“So?” Dean repeated, leaning back into the couch. He ran a hand over his face, rubbing at his eyes with forefinger and thumb and ending pinching the bridge of his nose. “Cassie…I didn’t even get my GED until I was nearly thirty. I’m basically a thug that took a medical terminology course. I’m a  _tech_. There’s nothing wrong with that, but…” Dean pursed his lips in frustration. “‘Out of my league’ doesn’t even begin to describe it.”

Cassie sighed heavily. “Dean,” she said, pushing her TV tray to the side and shifting on the couch so she was facing him, “I’m going to lay down some facts for you, and so help me if you don’t stop wallowing in self-pity long enough to listen.”

She held up a finger. “You are by far the hottest guy to ever step foot in Summit Surgical Center. Possibly all of Kansas – I’d need to do research. And if he hasn’t noticed that, then he’s required to hand in his gay card.” She paused. “He is gay, right? You’re not pining after a straight man?”

“I don’t even know why we’re having this conversation,” Dean said flatly, “but yes, he is.”

“Good.” Cassie held up another finger. “You’re smart. Not just book smart – anyone can do that – but you’re  _smart_. You see conclusions I couldn’t come to with the cliff notes and a Complete Idiot’s Guide to Whatever. And you remember everything. Every little detail, every nuance, and then you can put it all into a bigger picture. That makes you an amazing tech. I’ve told you this before. You’re a better tech than I was, and I’d been doing it for ten years before I precepted you.”

Dean said nothing, which Cassie took as an invitation for her to continue. She held up another finger.

“I’ve seen you without your shirt on.” Cassie turned her three fingers into a thumbs up.

“You already said that,” Dean mumbled.

“It merits repeating.” Cassie held up her fingers again, this time adding a fourth. “You said ‘outside the OR.’ That means you’ve spent time with him outside the OR. Privately?”

“Well, in a bar,” Dean admitted.

“When have you ever known a surgeon to do that?” Cassie asked shrewdly. “Aside from company functions, when have you ever known a surgeon to spend time outside of work with their tech?”

Dean swallowed. “Never.”

“Exactly.” Cassie leaned back, apparently satisfied. “Dean, he doesn’t see you as a thug with a CST. You didn’t see his face light up when he walked in today and saw you setting up.” She raised her eyebrows. “Until about five minutes ago, I assumed you’d been sleeping together for at least a week.”

It was useless trying to hide the astonishment on Dean’s face. “Is it that obvious?”

Cassie’s smile had a bittersweet cast to it. “Dean, I know you. And you’re terrible at hiding what you feel, especially when you forget that in our line of work, we learn to read everything in a person’s eyes.”

II

He should have left three hours ago.

No, that wasn’t quite accurate; he should never have come in the first place. He should have told her that he would take a rain check. He should have done anything but agree to come.

Her hair still smelled exactly as he remembered it. She shifted his arm on her shoulder to snuggle more tightly against his side and he found himself unconsciously rubbing her upper arm, softly, with a lazy rhythm totally incongruent to the scene of total destruction on the television in front of them.

It felt like he had never left. It would be so easy to just flow with it, let the familiarity lull him into a trance and just let everything unfold.

“Why is it always New York that gets obliterated?” Cassie asked in a sleepy voice. “There are other cities.”

“Gotham gets it pretty bad sometimes,” Dean replied. “And they kind of had to be in New York. Stark Tower and all that.”

“Psssh. Plot.” Cassie flipped a hand at the screen and settled more firmly against his side, head on his shoulder.

Dean took a slow, deep breath. Uneasy as he was, he was unable to deny that this was…nice. The companionship, the closeness, the warm feeling of another amiable body pressed against his. The amount of comfort he was drawing from it alarmed him just slightly.

The soundtrack of the movie swelled dramatically. Dean ceased paying attention, staring ahead blankly at the moving lights and turning his thoughts inward.

He shouldn’t have come. If he hadn’t, he wouldn’t be here in this situation, wouldn’t feel himself slowly being convinced that maybe this wasn’t such a bad thing, after all.

Almost as though the him from two years ago was taking control, he turned his head to look down, and as if on cue, Cassie looked back up at him.

He shouldn’t. He knew that look, and he shouldn’t still be such a slave to it, but if there was one thing he’d never been able to resist, even now…

He was just lonely, he reasoned frantically with himself as her lips caught against his, slightly chapped and warm and unfolding something deep within his chest, like a key turning in a rusty lock. Lonely and starved for some kind of human interaction and she wasn’t Dr. Novak and she definitely didn’t even have the equipment but…he had been happy with that, once.

If just for a night, maybe he could figure out what exactly “not straight” and “it’s complicated” meant, and then tomorrow, go back to being friends.

III

Her hair fanned out over the pale yellow of her pillowcase as she turned over. Dean’s mouth quirked in a small smile.

The glass of water on her nightstand stood next to two Tylenol tablets. With luck, if she awoke tonight, she’d see the water and drink it. She’d need it.

His mind wandered back to earlier that evening. “I’m sorry,” she’d mumbled as Dean broke away. “I know – I’m sorry.”

“Cassie,” Dean had said seriously, “The ‘it’s not you’ excuse is stupid, but…it really isn’t.”

“No, I…” Cassie sat straight up, gathering her hair into a bunch that she ran through her hands in consternation. He remembered that idiosyncrasy of hers well. “I need a drink,” she’d declared, twirling the throw blanket over her shoulders as she stalked off to the kitchen.

He hadn’t followed her, had simply leaned back into the couch, palms pressed against his eyes hard enough to see sparks of light. It had been so long since he’d done something stupid. Clearly he had needed to break that streak.

Cassie made a small, unsettling noise in her almost-sleep, and Dean sat down on the edge of her bed. If she was going to be sick, he wanted to make sure she didn’t choke on it.

It wasn’t whiskey she’d plunked gracelessly in front of him, but it had the same golden color. He’d looked at her with a raised eyebrow.

“It’s a honey liqueur,” she said shortly. “Only hard stuff I have.”

“You don’t want to do this,” he’d started, but Cassie had taken a long sip and downed half her glass before glaring at him.

“Were you paying attention when I tried to seduce my gay ex-boyfriend?” she asked grimly. “Of course I want to do this.”

Dean had not even corrected her with “not straight;” he’d simply shaken his head and swirled the liquid in the glass. On the screen the credits to the movie began to roll, casting the room into semi-darkness as the screen changed to white text on a black background.

“I really thought I was over it.”

“You seemed over it,” Dean offered.

“I was. I really was.” Cassie finished the rest of her drink with a quick swallow. Dean doubted she was even tasting it. “You…” She shook her head. “Are you even going to drink that?” she had demanded.

“I know what comes next,” Dean had said grimly. “One of us should stay sober for it.”

Five minutes had passed in the darkness of the bedroom; Cassie was breathing the deep, even cadences of very sound sleep. Carefully, he rose, trying not to rock the bed, and padded out of the bedroom, leaving the door open.

He paused at the doorway, his shadow stretching across the small bedroom to land as a gray silhouette on her comforter.

“There’s not a day that goes by I don’t wish you didn’t have to get hurt,” he said to the darkness. “But I did right by you. Then and now.”

The couch was still familiar; the blankets were still in the linen closet where he recalled, more threadbare now and with some new additions. He pulled two out and settled on the couch, spreading them over him and sighing deeply through his nose as he closed his eyes.

IV

There is always an element of awkwardness to the morning after, no matter what happened – or failed to happen – the night before.

Dean had not enjoyed the rest that Cassie had; too many times he’d awakened from his fitful doze to walk quietly to her door and watch, making sure he saw her chest rise and fall at least twice before heading back to his resting place on the couch. By five-thirty he’d given up on sleep entirely, his internal clock telling him it was past time to wake up and go to work, and he settled on sprawling on the couch with a book.

Cassie had clearly forgotten to turn off her alarm; at a quarter to six he heard the local news radio click on in her room and a loud groan before it was silenced.

Several minutes passed before he heard her call hesitantly, “Are you still here?”

He considered staying silent to scare her before deciding that it would be more cruel than funny. “Out here,” he called back.

Moments later she appeared in the living room, still looking closer to asleep than awake. “You are so noble it makes my teeth hurt,” she declared before shambling into the kitchen.

“That might just be the hangover,” Dean supplied as he put the book to the side and followed her.

She had jammed a cup into her single-serve coffee machine and jabbed at the button with rather more force than was necessary, and was now staring at the stream of coffee with obvious impatience.

“Water would be better,” Dean suggested.

“No talking before coffee,” she said without any real conviction.

He got her a glass anyway, forcing it into her hand. She put it down to reach for the steaming mug of coffee; with the much faster reflexes of the hale and not hungover, Dean grabbed it first and held it out of her reach, pressing the water into her hand.

“Water first. Then coffee.”

“I hate you,” Cassie muttered as she brought the glass to her lips.

“I know.” Dean watched her drink the glass in its entirety before he let her snatch the mug from him.

“No, I really hate you,” she said after a long steady sip that left Dean wondering if she’d burned all feeling from her tongue years before. “We were the cutest fucking couple ever and then you had to go and be gay but still love me and so we tried to make it work because we were young and stupid and…” She shook her head. “Did I not get all of this out of my system last night?” she demanded.

“You kind of passed out,” Dean pointed out. “But you’d started to repeat yourself, so I’d assumed you were done.”

“Obviously not.” Cassie rubbed one eye. “But yes. I hate you. We’ll leave it at that.”

Dean nodded, taking the glass to the sink and filling it again. “If it helps, I hate me, too,” he offered as he held out the glass again.

“Nope. Not allowed.” Cassie took the glass without a fight, leaning back against the counter and sighing. “God. How did we get so fucked up?”

Dean shook his head. “Can we just…not do this?” he asked plaintively. “Personally, I’ve had my fill.”

“I know.” Cassie pushed her mug back into the coffee machine and loaded it with another pod of coffee. “I have too. But you’re in my kitchen and I can’t seem to come up with another topic of conversation.”

“I can go,” Dean offered. “Now that you’re up and not dying.”

Cassie stared at him. “You are insufferable.” Her second cup of coffee was already to her lips.

Dean raised his hands in defeat. “I’m sorry I stayed last night to make sure you were all right. Obviously I should have left.”

With a heavy sigh, Cassie plunked her mug down on the counter and leaned over across the narrow galley kitchen, wrapping her arms around Dean’s torso. “You deserve so much better than Novak,” she said from somewhere around his collarbone. “But you’re the best he’s ever likely to get, so thank God for small miracles for his sake, I guess.”

Dean frowned. “Are you still drunk?”

“Probably.” Cassie let her arms drop as she leaned back. “You are a rare creature, Dean Winchester.” She picked up her mug again and took a sip, watching him over the rim.

“I don’t suppose you’d care to elaborate on that.” Dean had given up on following the thread of the conversation.

Cassie gestured at him with her mostly-empty mug. “You are so worried about other people. Making them happy. Making them safe. Doing the right thing for them. Without a single thought to what you want.”

“I wanted to make sure you didn’t die,” Dean said slowly, almost certain he was missing the point entirely. “You kind of downed half a bottle of Celtic Crossing.”

Cassie shook her head. “Not just me. Everyone.” Her eyes took on a shrewd cast that made it perfectly clear that she was not as hung over as she appeared. “You’re holding back for a reason. And I think I’ve figured out what it is.”

“Oh, well, good,” Dean said, a tiny flare of annoyance alighting in his chest. “At least someone has.”

“You remove yourself from any situation where you can’t make someone happy.” Cassie’s voice was triumphant as she declared this.

Dean stared. “And?”

“And,” Cassie continued, “you’re extending it to not letting yourself even enter a situation where you think you won’t make someone happy.”

“Okay,” Dean said, nodding. “I’m lost.”

Cassie made an impatient sound. “We broke up because you were convinced I wouldn’t be happy dating a gay man. Which, okay, fair assumption to make. And correct. I guess.” She turned and opened the refrigerator. “And now you’re convinced that a surgeon won’t be happy with you. So you won’t even try.”

“How did this become about me?” Dean asked, bewildered.

“I started deflecting because things were getting weird. Eggs?” She looked up, eyebrows raised inquiringly. “Anyway. I think you’re asking the wrong questions.” She pulled out a cardboard carton. “Would  _you_  be happy with the surgeon?”

“This is less weird?” Dean closed his eyes and ran his hand over his face. Suddenly, sleeping for three years seemed like a very good idea.

“It’s a simple answer, Dean,” Cassie said, pausing in taking down a bowl from the cupboard. “Would you be happy?”

“I don’t –”

“Yes or no.”

“Cassie –”

“ _Yes or no_.”

“Fine. Yes!”

Cassie nodded, as though pleased with herself for wrenching the confession from him, and finished pulling down the bowl. “Then stop thinking of him as a surgeon. That’s where you’re getting caught up. He’s not a surgeon, and you’re not his tech. He’s a dude – kinda cute, from what I could see, although the loupes really do nothing for him – and you’re a dude, and you’re both into dudes, and you should see what happens if you decide to try being into each other.” She opened a drawer and plucked a fork from it. “And just fucking be happy for once. For you.” An eggshell flew past into the garbage pail behind him. “Eggs? No eggs? Your call.”

V

Ice had formed a thin shell on the windshield of Dean’s car. Groaning to himself, he reached inside for the ice scraper, knowing that his defroster definitely was not up to the task.

“You gonna be okay?” he asked, leaning over to scrape at the windshield.

Cassie pulled her hoodie more closely around her. “I’ll be fine,” she said, her words fogging the frigid air.

“I don’t just mean today,” Dean said, pausing in the chore to look gravely at her.

“I know.” Cassie smiled faintly. “Yeah. There’ll be some times that I’m not. But that’s life.”

Dean nodded. He surveyed his work; it would do until the car warmed up. “Listen,” he said, turning to face her. “This is…weird. And uncomfortable. Because we’ve still got something that won’t give up.” He shrugged. “But if anyone ever tries you hurt you half as much as I did…”

Cassie raised an eyebrow.

“…when  _you’re_  done keelhauling him,” Dean said quickly, “ _I’ll_  break his kneecaps. So that he thinks twice. Because it’s bad enough that you beat yourself up over us. I don’t want you ever beating yourself up over some douchebag.”

“You’re impossible.” Cassie crossed her arms. “Take care of yourself, okay?” She put a very slight emphasis on  _yourself_ , erasing any doubt as to what she meant by the statement.

“You too,” Dean replied. He wrenched open the car door and slid into the seat, shivering at the cold leather.

The car roared to life, protesting only a little at the temperature, and Dean folded his arms as he waited for the engine to warm up, watching Cassie disappear up the stairs into her apartment.

He should have left thirteen hours ago, but some part of him was glad he hadn’t.


	15. Interlude: A Sense of Permanence

**Notes for the Chapter:**

> Cas’s microwave beeped, but he ignored it as he stared in mild dismay at the lease in his hands. They’d printed it with both their names, evidently just using what they’d already had on file.

He clearly remembered calling the landlord a year ago, and speaking the words: “I need a new lease. Andrew Davis isn’t going to be living here anymore.” He had hardly believed the words himself; Andy was still in the process of moving out, shifting his boxes little by little while Cas was at work.

He’d still left plates of dinner for Cas, small apologetic gestures that Cas hadn’t been able to bring himself to eat. Not out of spite – not exactly, anyway – but out of some mechanism of self-protection to distance himself from the life they’d shared as rapidly as possible.

Cas had done well in the intervening year. He’d refused to let the breakup muddle things in his professional life; he’d finished his fellowship and become a full-fledged surgeon at the very same hospital. And now there was nobody waiting at home to tell him he was being unreasonable, irritable, or any of the other unpleasant adjectives Andy had thrown at him during the two and a half years that their relationship had begun to fray at the edges.

But seeing Andy’s name printed next to his on the lease for the next year unleashed a wave of unspeakable sorrow that made the back of Cas’s throat ache. It wasn’t Andy specifically that he missed; he was far past that now. No, it was…companionship. He surprised himself by wishing that he did have someone at home who would tell him he was being ridiculous. Another name on the lease. A sense of permanence outside the always-changing but never-different march of events at the hospital.

He put the lease down on the table. Enough time to take care of it tomorrow.

Dinner in the microwave ignored – he wasn’t hungry anyway – he flipped open his laptop with the vague intention of responding to an email from his mother when one of the newer emails at the top of the list caught his eye.

He opened it to make sure it wasn’t spam; it certainly didn’t look like it. The headhunter who had sent it knew his name, surgical specialty, employment history… Brow furrowing slightly, he scanned the rest of the email before leaning back, eyes drifting to focus in the middle distance in thought.

“Kansas, huh?”


	16. December: There Will Be Other Mondays

**Notes for the Chapter:**

> I

When Dean had been twenty-two, he’d had a cough so bad that he cracked a rib. His entire body had ached, his throat felt torn to shreds, and his father had actually been roused to a level of concern high enough to scrape together their reserve of cash to take Dean to a doctor.

It was the sickest Dean had ever been in his life, and it didn’t hold a candle to how he felt right now.

It had descended upon him ruthlessly on Thursday afternoon, beginning with a burning ache at the back of his throat and spreading outwards rapidly until, at home, he could barely swallow the capful of NyQuil he’d found in the medicine cabinet. Still optimistic – rarely had any bug knocked him down for more than a few hours – he had collapsed into bed, only to be woken several times by a ripping pain in his throat.

When his alarm had gone off the next morning Dean had sat up to discover that his center of balance had apparently shifted some thirty degrees on its axis, a side result, he assumed, of his sinuses being so congested that he couldn’t hear out of one ear. His skin had the strange, oversensitive quality of feeling chafed, even by the soft cotton of his bedsheets, and though it was warm in his room, a chill spread through him with such force that he shivered.

For the first time in his history of gainful employment, Dean had called in sick.

Sam had brought home Dean’s favorite won ton soup; Dean had hardly been able to taste it, and had only tolerated swallowing it for the fleeting relief it brought to his throat as it went down. It was the first thing he’d been able to force himself to eat all day.

The weekend passed without much improvement. Dean was starting to suspect he would smell like lemon-honey throat lozenges for weeks.

As Monday dawned – or, rather, approached dawn – Dean woke up long enough to speed-dial the sick line and croak his name, almost not bothering to hang up before tossing the phone to the side and closing his eyes again. Sleep, however, did not seem terribly likely without pharmaceutical assistance; while he was awake, he may as well force down some kind of sustenance before he made the descent into another antihistamine-fueled doze.

“You look terrible,” Sam commented as Dean shambled past the kitchen table, blanket hanging from his shoulders.

Dean grunted in response. Now that he was looking at the food available, he didn’t want to eat any of it.

“I brought home some cans of chicken noodle soup,” Sam offered.

“It’s five in the morning,” Dean said, his voice like wrinkled sandpaper. Sam winced.

“Please tell me you called in.”

“No.” Dean coughed. “Don’t I look like I’m totally up for surgery today?”

Sam shot him a look. “You need me to restock the medicine cabinet on the way home?”

Orange juice. That would do for now. Dean poured himself a small glass of it, grimacing before he took a painful sip. “Some cocaine would be awesome.”

Sam blinked. “What?”

Dean gestured at the bridge of his nose. “Not crack. Topical cocaine. The green stuff we use in sinus surgery. Shrinks swollen tissue like you wouldn’t believe. If I had some of that I might almost be functional again.”

“Right,” Sam said slowly. “How about some Afrin, or something else I can get legally?”

“Amateur.” The last of the orange juice slid down his throat with slightly less pain than the first sip. Dean gave his glass a cursory rinse before shoving it in the dishwasher. “Yeah. Sure. And more NyQuil, too.” He closed his eyes against the small dizzy wavering that momentarily swelled through him. “I’m going back to bed.”

“Good.”

He didn’t actually remember trudging back up the stairs, nor clumsily pouring himself a capful of the bitter green syrup that had made life only just bearable this weekend. He made a face at it. “Used to be a time I liked doing shots,” he muttered before upending it.

His bed still held his body heat, but Dean still shivered as he drew his blankets around him into a cocoon.

“This sucks so hard,” he mumbled as he shut his eyes.

II

Sunlight was slanting through the gaps in Dean’s blinds. He blinked groggily, wondering what had woken him with such a start, when his phone vibrated between the bed and the wall again in a loud clatter.

His bleary eyes failed to make sense of the phone number, and he considered ignoring it entirely, but by accident he thumbed the answer bar to the side and the decision was made for him. He brought to phone to his ear as he ducked his head under the covers. “Hello?” he croaked.

“I suppose that answers that question.”

Dean swallowed, thoughts lurching ungracefully into gear as he recognized the voice. “Doc. What question?”

“I heard you were really sick. I was going to ask if you were okay. Clearly not.”

A concept unfurled slowly in his mind like cream in coffee. “Shit. It’s Monday, isn’t it? I missed you. I mean, your day. Monday. Today.” Dean shook his head in an effort to stop talking.

“Did I wake you up?”

“Kind of.”

“You should go back to sleep. I just wanted to…you know. Check up on you.”

“Sorry I missed Monday.” Dean tried to clear the fog in his head by rubbing his temples. “Was looking forward to it. Dammit.”

“It sounds like you made the right choice. Don’t worry. There will be other Mondays.” Dr. Novak sounded gently amused. “Go back to sleep.”

“Right.” Dean closed his eyes. Not for the first time, he wished he had blackout curtains. The sunlight would make Dr. Novak’s request difficult. “Good night. Afternoon. Morning. Is it still morning?”

“Just barely. Feel better, Dean.”

“You, too.” It took a moment for it to register why that statement was out of place. “Not that you feel bad. Or need to feel better. I –”

The phone beeped, indicating that Dr. Novak had probably hung up before Dean had started babbling. A distant part of him decided that was probably a good thing as he closed his eyes and drifted off into another doze, phone still in his hand.

III

All told, it was five days before Dean’s fever went down, and seven before he was confident in his ability to stay on his feet for an entire shift. His knees still felt decidedly weak, and he had to take a seat often; by the time Friday afternoon rolled around and his shift ended, Dean was almost dreading the text that always came at this point.

Except that it didn’t.

Dean loitered in the locker room for twenty minutes, not admitting that he was giving the text time to arrive. Which it didn’t.

He went on a brisk walk to the bar – it was only three blocks away, and he needed to stretch his legs after his week of convalescence, he reasoned – but the corner booth held three college-age boys, and the now-familiar head of slightly tousled dark hair was nowhere to be seen.

Three blocks was a lot longer from the other side of sharp disappointment. Thoroughly chilled as he pulled open his car door, Dean checked his phone once more.

Still nothing.

It remained stubbornly silent the rest of the evening.

As Dean watched the date change on his clock by his bed, he wondered if maybe time was the great equalizer, and if the two weeks since Thanksgiving had cooled the simmering potential that had been steadily gaining heat.

Or maybe he’d imagined the whole thing.

IV

If he shifted that lunch bag sideways and moved the various loose containers of this person’s lunch into the door where there was room, there might be enough room for Dean to shove his lunch bag on the bottom shelf. With a glance at the time – still five minutes before he had to clock in – he crouched and set to rearranging the bottom shelf.

“Dean?”

Dean glanced up, hands full of plastic containers of rice and vegetables, and had to consciously control the spread of the grin across his face. “Morning, Doc.”

“Feeling better?” Dr. Novak ventured all the way into the break room, the two cups of coffee held before him in gloved hands.

“Loads.” Dean realized he was still holding the pieces of another person’s lunch and he rapidly shoved them into the door as he stood. “Was back at work on Friday, actually.”

Dr. Novak nodded. “Good. I was worried I’d have to drink both of these myself.” In the gesture Dean had learned so well in the past several weeks, the surgeon offered Dean one of the coffee cups. Dean reached out to take it, a grin tugging at the corner of his mouth despite himself.

“Thanks.” Dean took a sip, heedless of the temperature.

“Have you eaten already?” Dr. Novak asked abruptly, as though he had been fighting with himself to say it.

Dean swallowed hastily. “No, I – I usually wait until morning break.”

Dr. Novak nodded and dug his free hand into his pocket, glancing down at his own coffee cup. “Our first case canceled,” he said, more slowly, “and the second one isn’t set to check in for another hour. I was thinking…maybe grab some breakfast?”

It was several seconds before Dean realized his mouth was hanging slightly open. He snapped it shut before it had the chance to say anything stupid. “I – yeah. Just – let me clock in and check the case carts for the rest of the day first.”

“Right.” Dr. Novak nodded and pulled a chair out from one of the tables. “I’ll wait here. No rush.”

V

Breakfast proved to be sausage and egg burritos from the grocery store across the street, the haven of all surgical center staff who had ever forgotten a lunch or skipped their bowl of cereal. The worker behind the counter had disappeared after punching a few buttons on the microwave, leaving Dean and Dr. Novak to shift uneasily as the microwave’s beeping went unanswered.

“So, uh,” Dean found himself saying before he had time to consider whether it was a good idea, “Friday.”

“Friday.” Dr. Novak nodded, looking slightly chagrined. “I was on a plane. College friend was getting married. I was going to tell you, but you didn’t seem likely to remember that I’d even called at all –”

Dean held up a hand. “No! Not – I meant this Friday.”

Dr. Novak cocked his head quizzically. “This Friday?” Comprehension dawned on his face as, finally, the worker returned to stifle the beeping of the microwave. “The Christmas party. Right.”

“Yeah. Thanks,” Dean said to the worker as she handed him the paper plate with his burrito. “You going?” he asked Dr. Novak casually.

“Maybe. I don’t really do company holiday parties.” Dr. Novak paused before taking a bite of his breakfast. “Are you going?”

Dean shrugged, not wanting to appear too eager. “It was fun last year. Might check it out.”

Dr. Novak made a noncommittal noise as he chewed. “We’ll see. I don’t have anything else going on.”


	17. December: Looks Like It's Gonna Hail

**Notes for the Chapter:**

> I

Dean pocketed the slip from coat check, rubbing his hands together briskly to warm them after his walk from parking the car. For the thirtieth time since he’d rolled them up, he considered unrolling his sleeves and buttoning them like a civilized human being; at a glance he could see that nearly everyone in the event hall was more smartly dressed than he was, and being underdressed had always made him feel conspicuous.

“Should have worn a tie,” he muttered to himself as he returned a wave to one of the other techs. “Sam has ties. He’d have loaned me one.”

Nearly everyone was already in their social clusters around the event hall, and even Sam and Jess had found a group to mingle with in the short time since Dean had dropped them off before parking. The dance floor in the center was conspicuously empty, as it nearly always was this early in the evening. He could see event staff making their rounds with their trays of hors d’oeuvres. He scanned the room quickly, heartbeat quickening in anticipation, but Dr. Novak was nowhere to be seen. A twinge of disappointment thrummed against his sternum but Dean opted to ignore it, heading over to the cash bar and snatching three hors d’oeuvres on the way.

“Dean!”

Dean turned expectantly before the voice registered as female; a smile came to his face anyway as he recognized the owner. “Charlie. I haven’t seen you around lately. I thought you’d ditched us.”

“I kind of did for a while,” the red-haired radiology tech admitted. “My mom…I finally said goodbye.” A hardness appeared behind her eyes.

“I’m sorry.” The words were thin and inadequate, but Charlie nodded at the small comfort.

“Anyway. There was all sorts of stuff to take care of after that, so I cut back to per diem. But I think everything is done now, so I’m back to full time.” She offered a smile, which, while brittle, still seemed genuine. “You were out most of last week, which was my first week back.”

“Ah.” Dean nodded, raising his bottle of beer to his lips. “And who is this lovely lady?” he asked as another woman came up behind Charlie and tapped her on the shoulder.

“Oh!” Charlie’s smile instantly became warmer as she reached out to pull the other woman closer. “Dean, this is my girlfriend, Dorothy. Dorothy, this is Dean. I’ve been working with him for…three years or so, now.” She looked to Dean. “We met about two months ago.”

“Good to meet you,” Dorothy said, holding out a hand. Dean took it, shaking it firmly.

“Likewise.” To Charlie, “Good grip. I like her.”

“So what do you do?” Dorothy asked Dean.

“Surg tech. You?”

“Parole officer,” Dorothy responded, making Dean’s eyebrows shoot straight up.

“Wow. What’s that like?”

Dorothy began to speak, but a movement at the door to the restrooms caught at the edge of Dean’s vision and suddenly all his attention focused on one spot in the room; even from across the dance floor Dean recognized the angle of the jaw and the way the fingers curled around the cup of the wineglass.

“Earth to Dean,” Charlie said, waving, and Dean blinked, suddenly disoriented. Charlie looked faintly amused as she followed the path of his gaze and her eyes lit on Dr. Novak. “Ah.” She lifted her champagne glass to her lips, eyes sparkling conspiratorially. “So the rumors are true. Or at least the nice ones.”

Dean swallowed the words he’d been about to say. “There are rumors?”

Charlie raised an eyebrow. “Like, seventy people work here. There are always rumors.” She took Dorothy’s hand. “Dean wants to go flirt, but he’s not rude enough to say so,” she said with a wink at Dean.

“It was nice meeting you,” Dean said graciously at Dorothy’s arch look, which appeared to mollify her.

“You too.” She shot a glance across the room just in time to see Dr. Novak’s eyes lighting on Dean and his small wave. “Good luck,” she added as Charlie led her away.

Dean took a breath, tugged on the bottom of his shirt to straighten it, and began to make his way across the room.

II

“You made it,” Dean said uselessly, gesturing with his beer bottle. He tried not to let his eyes linger, but Dr. Novak had made it very difficult; the vest he’d donned hugged his torso just so, showing off the lean lines that were always swallowed up by scrubs and surgical gowns.

“I did,” Dr. Novak confirmed, leaning back against the wall and crossing one leg over the other. He nodded out at the rest of the people milling about the event hall. “More of a turnout than I expected, to be honest. I guess I thought people would be traveling, with the center closed Monday and Tuesday and Christmas.”

Dean shrugged. “I’m sure some people are. I don’t see Dr. Angeles here, or Dr. Miller.”

“Gabe flew out to California on Wednesday,” Dr. Novak confirmed. “He’s got a new nephew.”

“Ah,” Dean replied.

A silence followed, punctuated by the light Christmas jazz music emanating from the speakers next to the bored DJ.

“So are you going anywhere for Christmas?” Dean ventured.

“Nah.” Dr. Novak took another sip from his almost-empty wineglass. “Christmas was never that big a deal at home. By the time I left home my parents had stopped the tree entirely.” He shrugged. “We’ll still send cards with money to each other. Usually we end up breaking even and wonder what the entire exercise was for.” He grinned, mostly to himself. “What about you? Any plans?”

Dean shook his head. “Sam and Jess are taking off on some romantic getaway. I’ve got the house to myself.”

He chanced a sidelong glance; Dr. Novak was chewing his lower lip in thought. “We should do something,” the surgeon said suddenly, looking up with an expectant light in his eyes.

“Yeah?” Dean asked, heart giving a strange lurch in his chest.

“Yeah,” Dr. Novak repeated, enthusiasm warming his tone. “Go see one of those horrible movies and get Chinese food. Or bring coffee to the grocery store employees who have to work.”

“You do realize you’re suggesting hanging out with your tech on your day off,” Dean said hesitantly.

Dr. Novak looked sharply at Dean; their eyes locked and Dean felt a thread of nerves wind through his middle. Dr. Novak licked his lips and took a breath. “You’re…not my tech when you’re not clocked in.” A ripple of realization crossed his face. “Is that why you always insist on calling me ‘Doc?’”

Dean swallowed. “Kind of.”

Dr. Novak switched his wineglass to his other hand and reached out to lay a hand on Dean’s shoulder. “Call me Doc when you’re getting paid to do it. Any other time…I’m Cas. Okay?”

Nodding, chest suddenly suffused with something lightweight and heady, Dean grinned. “Cas. Got it.”

III

The door prizes had all been presented, the toasts had been finished, and the savory hors d’oeuvres were making their shift to the sweet dessert bites. The music was now shifting to a slightly more upbeat playlist, though still not anything approaching what would get Dean out in the middle of the floor to exhibit his highly questionable dance skills.

Dr. Novak – Cas – had just returned from the cash bar with two beers, one held out to Dean confidently, and Dean took it with appreciation. From the corner of his eye, he noticed a tall, slender figure bent over, whispering to the DJ, and he shook his head and laughed.

“So,” he said, nudging Cas and jerking his head in the direction of the DJ. “You’ve met Balthazar, right? The OB/GYN doc?”

“Briefly,” Cas replied.

“Well. He does this every year, so fair warning. He’s going to go around and start dragging people onto the dance floor. Everybody. Whether they can dance or not. He used to be a West Coast Swing champion.”

“Did he now.” Cas’s expression had shifted from amused to thoughtful.

“He’s got the trophy in his office. So if he –” Dean was interrupted by Cas handing Dean his beer. “Doc? Cas? What…?”

Hands full, he watched in bewilderment as Cas tapped Balthazar on the shoulder for a brief murmured conference that reduced Balthazar to a momentary fit of giggles. They both turned to the DJ, who gave them a thumbs-up and turned to his laptop.

Dean was expecting it, but the sudden blare of horns from the speakers caught the rest of the room off-guard as the opening bars to what was unmistakably “Jump, Jive ‘n Wail” echoed through the room. Conversations were immediately silenced and Dean watched in growing bemusement as the two surgeons, one with an awkward grin and one clearly giddy with glee, began to dance with an enthusiasm Dean had assumed was reserved for the slot before prime-time television.

Scattered cheering broke out as they completed a series of complicated-looking spins, the entire room now watching the dervish in the middle of the dance floor. Cas was laughing now, the result of an aborted dip that Balthazar had attempted, but only a few beats passed before they were back in the rhythm, looking for all the world as though they had been rehearsing for weeks.

Dean was well aware that his jaw was hanging open, but he didn’t think he had the wherewithal to instruct his muscles to close it. People were applauding and catcalling good-naturedly as Cas warned Balthazar against trying to dip him again as the song ended, his shout clearly heard over the fading of the music. Balthazar laughed, hands on his knees as he doubled over, and Cas pounded him on the back with a wide grin himself before threading his way through the throng of people back towards Dean.

“I haven’t done that in years,” Cas said, eyes shining, breathing heavily. He reached up to loosen his tie around his neck, unbuttoning one button and shaking his head as though laughing at himself.

Even in the light that had grown dim to accentuate the dancing mood, Dean could see the flush in Cas’s cheeks. His hair had lost all semblance of being tamed, and stuck out at odd angles that were only slightly fixed by Cas raking a hand through it as he leaned against the wall, catching his breath.

Like a thunderclap, Dean felt an almost physical impact of sheer, unadulterated desire to touch, to hold close, to thread his own fingers through the tousled hair and give Cas another reason to be flushed and breathless. Irrationally, he started looking around the room for an excuse – any excuse – he knew that they usually hung some just for laughs –

“What are you looking for?” Cas asked, breathing mostly normal now.

Dean’s eyes darted to Cas’s face; the excitement that had shone from it a few moments ago was calming and smoothing the laugh lines from around the surgeon’s eyes. Dean swallowed.

He could answer “nothing” and let it go, and things would be as they always had been.

“Mistletoe,” he said instead, and waited for the fallout.

IV

Cas grinned. “I haven’t had nearly enough to drink yet for that,” he began, and then faltered as Dean held out one of the beers he was holding.

Amusement gave way to astonishment as his eyes shifted between the beer and Dean’s face. “You’re serious,” Cas said. It was not a question.

“Dead serious,” Dean replied, proud of the way his voice did not waver.

Very slowly, Cas nodded. “Dean,” he said, “I…think you’ve had entirely too much to drink, and it would be irresponsible of me to let you drive home tonight.”

Dean blinked. “What?”

Cas nodded again, more firmly this time. “We’re going to have to share a cab.”

Dean raised an eyebrow. “You’re really bad at this.”

“Yes. I am.” Cas took a breath and looked Dean firmly in the eye. “Come home with me tonight.”

The words reverberated up and down Dean’s spine in a delicious thrill. “Okay.”

V

“Here.” Dean pressed the car keys into Sam’s hand. “You take her home.”

“What?” Sam turned. “Where are you going?”

“I’ve…got other plans tonight.” Dean backed off with a lazy salute. “Have fun in wherever it is you’re going. Merry Christmas. Happy New Year. Don’t wait up.”


	18. December: God Rest Ye, Merry Gentlemen

**Notes for the Chapter:**

> I

Bashful, disbelieving, they talked very little in the backseat of the cab. Every time Dean glanced over he would inevitably catch Cas stealing a glance of his own and they would immediately look elsewhere. Dean was sure that Cas felt the same jolt of desire whenever their eyes touched; it was a rolling simmer now, a living thing under his skin, his body thrumming with it as it began to collect in pleasurable stabs in his groin.

“Here we are,” Cas said as the cab pulled to the side of the road, his voice smoother somehow at its quiet volume.

Dean looked out the window. “You live in a bakery?”

Cas chuckled as he flipped open his wallet. “There’s an apartment above it. I don’t know, it just…struck my fancy.” He handed the driver a few bills. “Keep the change. Merry Christmas.”

Dean peered in the dark windows as they walked past, eyes puzzling out the familiar machinery of an espresso machine. “This is where the coffee comes from.”

“Hmm?” Cas asked.

“Monday coffee. It’s from here.”

“Oh. Yes.” Cas grinned. “It’s close by, and they always have it ready for me.” He cleared his throat. “They’ve been making two cups for so long that they, ah, might want to meet you.” He pointed at a brightly-lit alleyway to the side of the bakery. “Stairs are back there. After you?”

II

Dean had a brief impression of an orderly, if small, space swathed in tones of gray and blue as he stepped into the apartment, but had little time for anything more than that before Cas closed the door behind them with a click and grabbed Dean by the shoulder, spinning him about. There was hesitation in Cas’s eyes as they locked with Dean’s, as though he wasn’t certain what to do now that they were finally here. The light from the window made sharp angles and planes of his face and Dean impulsively reached out to smooth his thumb over one cheekbone.

The intimate touch, so unlike anything else that had ever passed between the two of them, seemed to snap some sort of barrier. Cas grabbed at the lapels of Dean’s coat and pulled him close, their mouths meeting together so forcefully it would have hurt if Dean hadn’t had the split second of preparation. Dean could taste the champagne on Cas’s tongue and feel the other man’s stubble scratching the corners of his mouth as he pressed as much of himself as he could against Cas, acutely aware of Cas’s warmth bleeding through his overcoat and of his obvious arousal as Dean pressed their hips together, backing Cas up against the door in an abrupt outlet of the slow burn that had been building for the last half hour. Cas made a small noise of approval against Dean’s lips as he rolled his hips forward, one hand reaching around to the small of Dean’s back and pulling Dean closer, as though Dean had any notion of escaping.

The rough canvas of the overcoat had to go; it slipped from Cas’s shoulders in a muffled rustle as it dropped to the floor. The silk of Cas’s shirt was smooth under Dean’s hand as he ran it up and down Cas’s arm, feeling Cas fumble with the buttons on the front of his own coat and suddenly all the fabric between them was too much. Dean felt flushed and confined, and not appreciably less so as Cas navigated the third button and Dean hastily shrugged out of the heavy wool. He didn’t know what he wanted to do first – whether to divest himself of his shirt or Cas of his – and was irrationally considering the logistics of doing both simultaneously when Cas bowed his head and placed a hand on Dean’s chest.

“Dean.”

Slowly, thickly, as if awakening from a deep sleep, Dean blinked and took a deep, shaky breath. “You okay?” he asked, surprised at how husky his voice had become. He cleared his throat and swallowed, trying valiantly to distance himself from the aching need that pulsed through him.

“I don’t – I’m not playing a game.” Cas swallowed, his own voice considerably lower than normal, and closed his eyes before looking back up at Dean. “Are you?”

A tiny lash of cold horror licked at the warmth that had been suffusing Dean for the past hour. “Cas,” he said uselessly, the name still somewhat foreign and thrilling on his tongue, “I – no. I don’t – Jesus, where did you get that idea?”

Cas looked abashed. “Cassie,” he said simply. “There’s history there. It’s plain as day. I didn’t even have to ask if she was the one who…” he trailed off.

The tumblers began to fall into place, and Dean laughed weakly. “Yes. There’s history. But – it’s history, Cas.” He licked his lips. “I know the games. I don’t play them. Not anymore. You’re –” He let out an explosive exhalation. “There’s no way to say this without it sounding corny, but…” He swallowed. He’d not planned on saying this, but it was probably best to get it out in the open now: “I’ve never even been with a guy before. It wasn’t something I wanted to stumble into without…” He hesitated. “Without caring about it.”

He ignored the way Cas’s jaw slackened slightly in surprise and bulled forward. “It matters now. Back when I was aimless and stupid, yeah, I played all the games just trying to figure out what was supposed to be so damn great about it. I never found out, and gave up and settled for what I could get, which was Cassie, and…” He clenched his jaw. He was babbling, and he knew it; he should shut his mouth before he said something he’d regret, if he hadn’t already. He let his eyes fall to Cas’s shoulder. Vague feelings of shame twined through his stomach, as though he was seventeen again and scared shitless in Giselle Rhodes’s backseat, knowing what he was supposed to do and that he was supposed to  _want_  to do it and terrified of what it meant that he didn’t.

“It matters,” he said, if only to break the silence. “I wouldn’t be here if it didn’t. I’m not playing.”

Cas still wasn’t saying anything; it looked as though he was struggling to make a decision, gaze turned inward. Dean closed his eyes and sighed. He’d come to the wrenching conclusion that he should bend down to retrieve his coat when Cas nodded, once, and stepped past Dean into the dark apartment.

“I need to check something,” was all he said before he turned a corner.

A light flicked on, illuminating a long rectangle in the next room. Curiosity piqued, Dean ventured further into Cas’s apartment, stopping next to the gray sectional sofa that dominated the living room as he spied Cas through the lit doorway, digging through a bathroom drawer.

“Ha!” Cas barked in amusement as he studied a black box. He looked up, the sheepish grin on his face completely incongruous with the sobering exchange they’d just abandoned in the entryway. He threw the box to Dean. “They don’t expire for another three months.”

Dean looked down at the still factory-sealed box of condoms and felt a foolish smile quirk the corner of his mouth. “I didn’t scare you off?”

Plucking the box from Dean’s hands, Cas tossed it negligently to the table. With only the slightest air of self-consciousness, he reached out and laid a hand on Dean’s waist, drawing him closer. “Dean. I’ve spent weeks forcing myself to ignore how much I wanted you. And now I find out you don’t want a careless tumble. That this matters to you.” Without warning, Cas hooked his leg around the back of Dean’s knees, sweeping his legs out from under him and landing him ungracefully on his back on the couch in one smooth motion that made Dean let out an undignified shout. Astonished and catching his breath, Dean could only stare as Cas climbed astride him. “If you think I’m kicking you out after that…”

The weight of Cas on his thighs stirred the nearly dampened ardor, rekindling it in a heady rush. With a desperate air, Dean tangled his fingers in the hair at the nape of Cas’s neck and pulled him down, snatching his lips hungrily against Cas’s, who was clearly only too happy to respond in turn. Blindly, not wanting to break away, Dean groped for the knot of the tie around Cas’s neck, loosening it and then pulling it apart to slide out from under Cas’s collar. As if in answer, Cas undid the button at Dean’s throat and continued down with impressive haste, making a soft noise of frustration at Dean’s undershirt, which Dean thought slightly unfair – after all, Cas was wearing a vest that Dean would have to dispose of before he could even think of starting on the shirt.

The vest proved to be little difficulty, Dean’s deft fingers slipping the buttons through their holes with an earnest desire to remove every scrap of clothing from the man atop him as quickly as possible, halting only to allow Cas to pull Dean’s undershirt over his head. Dean’s skin prickled with gooseflesh with the exposure to the chill air, Cas’s hands hot as he ran them over the bare skin with obvious relish, leaning forward to press his mouth once again to Dean’s.

“Goddamn buttons,” Dean muttered against Cas’s lips as he started on the tiny ones of Cas’s shirt. In a stunning showcase of foresight, he kicked off his shoes and toed off his socks – there was no sexy way to remove socks, so he may as well do so while Cas was distracted with his belt buckle – and by the time Cas had worked his fly down and was tugging at the waistband of Dean’s trousers Dean had finally managed to not only slide Cas’s shirt from his shoulders, but he also was able to lift his hips and allow Cas to pull the trousers down past his knees, where they pooled around his ankles. Dean kicked them aside, suddenly very cold despite the flush of Cas’s bare chest against his.

“So this is what’s under the scrubs,” Cas murmured appreciatively as he rocked back, reaching behind him to tug at his shoelaces while Dean worked at his belt buckle. The shirt and vest still hung from his elbows, caught where the sleeves had been rolled up, and he slid his arms from them and let the offending garments fall behind him.

Finally down to just the thin cotton of their boxers, Dean felt the slightest twinge of trepidation. This was territory both familiar and vastly foreign, and he felt his fingers tremble slightly as he ran his hand down the lines of Cas’s torso to play his fingers along the curve of Cas’s cock through the fabric. Cas let out a soft exhalation against Dean’s neck – of pleasure, Dean assumed, and he felt his own cock twitch with it – and in a burst of courage he dipped his hand under the waistband and pulled Cas’s cock free.

Dean was in medicine; he had seen and handled more genitalia than most people did in their entire lives, but that was in an entirely professional manner. He’d never wrapped his fingers around the shaft of a cock that wasn’t his own with the intent of giving pleasure, and watching Cas’s head cant back and eyes droop shut, leaning backward at Dean’s touch, made Dean lick his lips involuntarily.

All at once, in a dizzying roil in his gut, he wanted things he didn’t even know how to ask for, wasn’t even sure how to name, and the intensity of the sheer need immobilized him.

Cas’s eyelids fluttered open and abruptly, as he took in the expression of near panic on Dean’s face, he seemed to understand. “Hey,” he said softly, leaning down and pressing his forehead to Dean’s. “Relax. I’ll take care of you.”

III

Dean’s throat felt parched from his series of low, ragged gasps as Cas worked a second finger into him, as excruciatingly slowly as he had the first. He shivered as Cas gently rubbed against his prostate, rolling his hips downward for more pressure. He’d somehow never gotten the correct angle for this by himself, never gotten past the sensation of his own sense of touch as he’d explored, but now his entire world had shrunk down to Cas and his hands and his mouth as he leaned down at uneven intervals to tease at Dean’s cock.

He rolled his hips downward again as Cas slowly began scissoring his fingers, the burn of the stretch no longer shocking, instead a promise that set a lash of need lancing through him. “More,” Dean said breathlessly, his tone very nearly begging.

“You want more?” Cas asked, almost amused, as he thrust his fingers in deeper and twisted in a motion that earned another buck of Dean’s hips.

“Want you,” Dean managed, forcing his eyes open as he propped himself up on his elbows to catch Cas’s gaze. Cas’s eyes, already dark in the dim light, were nearly black, pupils blown wide with lust. “God, Cas, I want –”

“Easy now.” Cas shifted to lean up and catch his lips against Dean’s, taking the opportunity to thrust upward with his fingers again in a motion that made Dean moan into the kiss. “This part is important.”

“I know,” Dean murmured, “I know, I just –” he broke off in a gasp as Cas slipped a third slick finger in beside the other two.

“But if you’re so eager, we can speed things along a little,” Cas breathed into Dean’s ear, before sidling down to gently tease at a nipple with his teeth.

“Fuck.” Dean threaded his fingers through Cas’s hair, now mussed beyond anything resembling propriety, his other hand going to grip the base of his cock tightly. Three times, now, Cas had brought him nearly to the brink, keeping Dean teetering there for long, torturous minutes. Dean was uncertain whether that could be attributed to Cas’s skill or his own hunger; likely it was a delicious combination of both that set him to tingling, overtuned to the slightest velvet rub of skin on skin.

With one hand, Cas pulled a condom from the box on the coffee table, even as he flexed the fingers of his other hand, carefully watching Dean’s reactions with relish. He ripped open the foil with his teeth – an image that nearly undid Dean right there – and leaned back to roll the condom down his length before slicking it with lube.

Even knowing what would come next, Dean whimpered as Cas withdrew his fingers, feeling the loss deep in his gut. Mute with desire he had no words for, Dean watched as Cas climbed up onto the couch from the floor, pushing Dean’s legs apart and positioning himself over Dean in the corner of the sectional.

“Dean,” Cas said, meeting Dean’s eyes. “Can I?”

Dean nodded, not trusting himself to speak, and shut his eyes as Cas carefully pushed the head of his cock against Dean’s rim.

The moment stretched in anticipatory ecstasy; Cas withdrew ever so slightly only to thrust shallowly again a little further, hands holding Dean’s hips steady, Dean holding his breath against the burn, trying to force himself to relax at the welcome intrusion. After an age of countless small shifts Cas let out his own breath in a long whoosh, letting himself fall forward against Dean’s chest, trembling as his cock twitched, finally fully seated.

Dean tried for a breath as Cas lay still to let them both adjust, reveling in the sensation as his body relaxed in small measures around Cas’s cock and he could instead feel the fullness of it, his muscles contracting in tiny spasms in response to the involuntary twitches as Cas fought against moving. Experimentally, Dean shifted his hips and both of them hissed in a sharp intake of breath.

“Careful,” Cas said in an oddly strained voice. “Or this’ll last about five seconds.” He reached up to cup his hand around Dean’s face, bringing him close for a sloppy kiss. “God, you’ve got me riled up.”

“Same,” Dean breathed, the sheer force of will required to keep his hips still making him feel as though he were about to fly apart. His cock was pressed between their bellies, the minute shifts eliciting a maddening sort of hot friction that made him unsure whether he should grind up or down. Either way, he knew that when they started moving in earnest, he would not last long before spectacularly breaking.

They lay there, breathing together, Dean feeling Cas’s heartbeat against his chest, until Cas braced himself against the back of the couch and slowly rocked his hips forward. Dean felt his eyes roll back as the shaft of Cas’s cock slid along his prostate with just enough pressure to release a ghostly thrill of pleasure. Almost reflexively he reached between them to grasp at his own cock and begin stroking it slowly, matching Cas’s measured pace as the other man carefully withdrew and then thrust forward again, this time angling himself just slightly upward. He hit his target; Dean could not stifle his moan and he felt his hand begin to pump more quickly in response to the overwhelming urge to come.

Dean felt a gentle hand on his and he opened his eyes as Cas pulled his hand up to the back of the couch. “Can you come from just this?” Cas asked, eyes needy as they caught at Dean’s.

“I don’t know,” Dean replied breathlessly, aching with the need for some kind of release. “Maybe?”

“Let’s see.” Cas thrust forward again, harder this time, and while he didn’t hit the same mark as squarely it still forced a wave of heat to join the tight coil at the base of Dean’s belly.

As though they shared a mind, they moved together, Dean rolling his hips downward to meet with Cas’s thrusts, their pace increasing gradually until Cas suddenly paused, stiffening. “Wait,” he gasped, head bowed, face screwed up with tension. “Wait just a –”

“So close,” Dean breathed, heedlessly pushing back against Cas’s rigid hips, “I’m gonna – Cas I’m gonna –”

With a crack of lightning behind his eyelids, all the hot tension unleashed violently, and Dean gave voice to a wordless, strangled shout as his orgasm wracked his body with wave after wave of sharp pleasure, spattering hot against his chest as it shot from his cock in thick ropes.

“God,” Cas croaked, his hands releasing Dean’s as he set them to Dean’s hips and he thrust, hard, repeatedly, making Dean shout again as a new pleasure spiked with every move. “Dean, you –” He groaned, low and guttural, as he stilled again, but this time the shudder and the twitching of his muscles made it clear that this was not a pause to collect himself. “Dean,” he said again, drained, as he lowered himself to Dean’s chest, mindless of the mess there, and snatched his lips against Dean’s neck.

Muscles still weakly spasming with aftershocks, they lay there as their breathing slowed to normal, loathe to separate and become two again.

IV

Warm.

Dean’s eyelids fluttered before opening wide in disorientation as he sat upright. There was a wall where there shouldn’t be, and the sheets didn’t smell right, and the blanket was heavier than he was used to, and the angle of the light was all wrong -

“Hm? S’wrong?”

Dean glanced down, heart racing, and as his gaze rested on the figure in bed next to him as it stirred awake, everything fell into place. “Nothing. Just – not used to this.”

“M’neither.” Cas reached up and clumsily grappled at Dean’s shoulder, pulling him back down. “You’re letting cold under the covers.”

“Sorry.” Dean pulled the duvet over his shoulder as he settled back into the pillow, smiling to himself as Cas threw a sleepy arm over his side and pulled him tight. He leaned back against Cas’s chest and closed his eyes.

Warm.

V

Familiar guitar chords jolted Dean awake; they were followed by the jostle of Cas reaching over Dean to shut off the clock radio in the middle of “Carol of the Bells.”

“Always liked that version,” Dean muttered as he rubbed his eyes.

“Sorry about the alarm,” Cas said, settling back under the blanket and pulling Dean close in an almost automatic gesture. “I usually get up early to go running on Saturday.”

Dean looked back at him with a raised eyebrow. “I really hope you arrange to have someone chasing you, because that’s the only excuse to go running at –” he checked the time – “seven o’clock on a Saturday.”

Cas snorted. “I like running.”

“But it’s  _cold_  outside,” Dean protested.

“I didn’t say I was going running  _today_.” Cas gave him a little squeeze. “There are more important things on my mind.”

“Oh?” Dean nestled against Cas’s front, feeling the stirrings of lazy morning arousal begin. “Like what?”

Cas smirked. “You are insatiable. Like breakfast.” He made as though to sit up, then slipped back under the covers. “But it’s cold, so I think I’ll stay here a little while longer.”

Dean turned over, and was momentarily overcome by the depth of emotion that struck him, seeing Cas’s face cradled in the pillow, hair dark against the light linen, eyes cloudy blue even in the steely silver light of predawn. That it was still shockingly incongruous with how he was used to seeing those eyes only made the thrill more profound.

Cas evidently felt something similar, because his already soft gaze melted further as he reached up to fit his hand perfectly at the back of Dean’s neck, pulling him in for an oddly tender kiss.

They had been lost in the fever pitch of passion the night before, and satiated exhaustion had claimed them soon after; this was a different kind of kiss, slow and sultry like warm honey, without the frantic pounding of hearts sounding the rhythm but something much smoother, much more akin to breathing. Time did not slow so much as suspend, enveloping them in a microcosm of warmth and languid exploration that was theirs and theirs alone.

It was Dean who pulled away first, mildly surprised to find he had rolled atop Cas. “I just remembered something.”

“What’s that?” Cas asked, curiosity alight in his eyes.

Dean leaned back into a sitting position. “Turn over.”

Cas’s eyebrows shot straight up, but without a word he shifted, wriggling under Dean as he turned onto his stomach.

Dean was not sure how to describe the sensation he felt as his eyes made out the details in the dim light; at once he was awed, amused, and vaguely aroused as he reached out to trace the lines that had blurred very slightly with the years. “A caduceus,” he said finally as his fingers trailed over one wing that took up almost an entire shoulder blade. “That makes so much sense I don’t know whether to laugh or cry.”

Cas groaned and shoved his face into his pillow. “Gabriel told you  _his_  story about it, didn’t he?” he asked, resigned, voice muffled by the pillow.

“He…hinted,” Dean hedged.

Cas propped himself up on his elbows so he could twist and look over his shoulder at Dean. “It wasn’t an accident,” he said plaintively. “You don’t _accidentally_  get a full-back tattoo. I’d been planning it for a while. I…” he smiled in slight embarrassment, his eyes focusing on the near distance as he remembered. “I wanted something with wings, because I was going through a phase, and since I was studying medicine, a caduceus seemed fitting. I didn’t want to go through with it until I actually got into medical school.” He exhaled a shallow laugh. “Probably should have waited until I wasn’t drunk to go ahead and do it, because I gave Gabe enough ammunition to torture me with misinformed fables for the rest of my life.”

“How long did it take?” Dean asked, tracing over the outlines of the intertwined snakes as they twisted down along Cas’s spine.

Cas gave a small shiver at Dean’s ministrations. “Twenty-six hours over five weeks. And really, the joke’s on me, because I can’t even show anybody. I tend to keep my shirt on in polite company.”

“Hey,” Dean said, switching his light touch to digging in his thumbs as he walked them back up on either side of Cas’s spine. “My manners are flawless.”

“Present company,” Cas gave a little grunt as Dean tread over a knot in his back, “always excepted.” He closed his eyes and let his upper torso fall back to the bed. “You can stop doing that in about three years.”

“I don’t know about that long,” Dean said with a grin, “But I don’t really have anything else planned for this morning.”

VI

The sweatpants and University of Washington tee shirt smelled like Cas, were just a shade too small in length and across the shoulders, and Dean had never been so thrilled to put on clothes that weren’t his. He sprawled on the couch in that slightly-self-conscious way of one who has been told to make themselves at home in a place that is wholly unfamiliar. It was ridiculous, especially since less than twelve hours ago Dean had had every stitch of clothing removed from him while he’d been on this couch, which almost certainly granted him liberties beyond that of a normal houseguest.

The creak of the door opening made him twist. “Don’t get up,” Cas called as he pulled the door closed behind him with his foot. Dean watched as he made his way into the living room, balancing two familiar, nondescript coffee cups atop a pink bakery box. “Apple and sausage croissants,” Cas explained as he handed Dean one of the coffee cups.  ”I wasn’t kidding about breakfast.” Hands freed, Cas pulled the handful of mail out from under his arm and began shuffling through it as he sank onto the couch next to Dean.

“Right,” Dean said, swallowing against the aroma as it manifested in the small living room. He glanced sideways. “I love the smell of conflict of interest in the morning.”

Cas winced. “That…occurred to me too. But we were busy at the time, and it seemed like a terrible opportunity to bring it up.”

“You kidding?” Dean grinned sheepishly. “You really think that knowing we shouldn’t be doing this doesn’t add a little something?”

“Maybe a little,” Cas admitted with a small smile of his own.

Dean nodded. “You know what I think?” He didn’t wait for Cas to answer. “I think we should ignore it until it comes around and bites us in the ass.”

Cas looked up from tearing open an envelope. “Somehow, I think that might be the philosophy for a lot of things in your life.”

Dean shrugged. “It got me into bed with a hot surgeon. I can’t say it’s steered me wrong yet.” He flashed Cas a smile that faded when he saw the color drain from Cas’s face as he scanned the sheet of paper in his hands. “What?”

Cas swallowed and nodded at the paper. “A subpoena.” He heaved a troubled sigh. “I expected this. It looks like I’m summoned for questioning about the circumstances of the murder of Victoria Wilson.” He looked up sharply. “You probably have one, too.”

Licking his lips, Dean leaned forward and rubbed his eyes. “And suddenly, things got a lot more complicated.”


	19. December: What Comes Next

**Notes for the Chapter:**

> I

He wasn’t on the boards.

Dean scanned them again, his brow furrowed. There were only two rooms running, which wasn’t that strange for the day after Christmas, but he wasn’t on the boards at all, not even assigned to breaks or special projects.

Determined to not let his concern show, he turned to head to the locker room to don his scrubs when Chuck stepped out from The Cage.

“Dean,” he said seriously. “Are you clocked in?”

“Not yet,” Dean replied.

“Go clock in, and then head to…do you know where Naomi Silverman’s office is? From HR?”

“HR?” Dean asked, stunned. “What does HR want with me?”

Chuck held up his hands innocently. “They’ve requested that I free up your schedule for you to go visit them, and that’s all I know.”

“Right.” Dean wiped at his mouth nervously. “I guess I’ll see you later.”

II

Human Resources had their offices on the fifth floor of the surgical center, where most of the other administrative work happened. Unlike the third floor, the fifth floor had plentiful windows that overlooked the city’s skyline, which hadn’t changed much in the three years since Dean had last been called in to have a conversation with Naomi.

He was fairly certain he knew what the basic shape of the conversation was going to be, and was already constructing arguments as to why it was unnecessary.

First, he decided as he returned Naomi’s overly genuine smile and sat down before her desk, he’d play dumb.

“I’m not going to mince words, Dean,” Naomi began as she folded her hands in front of her. “Brass tacks only. First of all, I want to assure you that you’re not going to be punished for anything you say, and that we will keep anything you say as anonymous as possible.”

Dean blinked, and all his half-formed arguments fled. “What?” he asked.

Naomi looked at him with utter sincerity. “It has been brought to our attention that there are concerns about…inappropriate overtures made by Dr. Novak towards you.”

Dean stiffened. “I’d say that’s between me and Dr. Novak.”

“And under normal circumstances, I would agree,” Naomi replied smoothly. “But…Dean, I need you to understand that despite the legal issues surrounding that occurrence in September, your job is not in danger.”

The dots were not connecting. “I never thought it was.”

Naomi looked truly troubled now. “No, you misunderstand. Your job is not in danger, whether Dr. Novak chooses to defend you or not,” she said, slowly and clearly.

Like tumblers in a lock, what Naomi was driving at slammed into place. “Wait. You think I’m –” Dean shook his head violently. “No. Whatever you think is happening, it’s not happening that way. Cas isn’t – Dr. Novak isn’t  _extorting_ me. Jesus. Where did anyone get that idea?”

“We’ve received numerous complaints concerning the way Dr. Novak treats surgical center staff,” Naomi said calmly. “And your record…let’s just say it indicates that you may be…vulnerable…to offers of privilege.” She unfolded her hands, holding them before her in a gesture of kindness. “Combined with some of the rumors that have made their way to us, you can see why we have cause to be concerned for your welfare.”

“I’m not hearing this.” Dean pressed his palms briefly against his eyes. “Dr. Novak is not some – some evil villain. Those normal circumstances, where you agree that everything is between me and him? Yeah. These are normal circumstances. No extortion, no – what did you call it? No  _privileges_. While I’m on the clock, he’s Dr. Novak and I’m his tech, and that’s all you guys up here need to worry about.”

“If he is mistreating surgical staff, we need to report it to the medical group so they can consider his continued employment,” Naomi countered coldly.

“I wouldn’t call what he does mistreatment,” Dean replied without thinking, “on the clock or off.”

“Abuse of his authority is mistreatment,” Naomi said pointedly.

Dean opened his mouth as though to say something, but realization dawned on him. “You want him gone,” he said slowly. “You’re going to twist anything I say into evidence for your little report to the medical group that he should be fired. You’ve probably been sitting on this problem for months, looking for the right loophole, because you can’t fire him just for being an asshole, and even if the lawsuit was messy, he can’t be fired for that. But damn, you sure could spin the idea of him sleeping with a tech, couldn’t you? What, make me into some tragic little misguided idiot?”

“You’re getting agitated –” Naomi began, but Dean cut her off.

“No, I’m beyond agitated. I’m  _pissed off_. I could live with everyone thinking I slept with someone to get this job, because everyone who mattered knew it was bullshit. But everyone –  _everyone_  – is so willing to see Cas as the bad guy that they will eat this right up, and I refuse to dance to your drum to help kick him out.”

“I think we’ve exhausted the possibilities of his conversation,” Naomi said icily.

“I think we’re just getting started,” Dean shot back. “Just think of all the possibilities we haven’t covered! Trying to figure out how to neutralize the shitstorm from having one of our surgeons associated with a murder case? Do you really think getting rid of him will make our reputation shiny and new again? You’re willing to shit all over his name to keep a backwater armpit of a surgical center out of hot water?”

“Dean, please don’t make me call security to have you removed.” Naomi’s voice was steel now, but Dean did not waver.

“Oh, I’ll go. And have fun replacing me.” He slipped his badge from his belt and held it up, reading the back of the badge. “It says I have to return this to security when I end my employment at Summit. Do me a favor, will you?” Dean tossed it to her desk, turned on his heel, and stalked from the office.

III

His hands were shaking, making his stabs at the ignition with the key reckless and fumbling. Resisting the urge to throw them across the car, Dean tossed them into the seat next to him and leaned back against the headrest, taking great gulps of air to calm the seething frustration that soured his stomach with its intensity.

Four years he’d been here; not long in the grand scheme of things, but the longest he’d ever been in one place for any amount of time. He’d seen management changes, a few retirements, a few marriages and divorces. Gone, now. All of it. The boards, the friendly rapport with the surgeons…

Was it worth it? Was his pride really that important to him?

Not just his pride, he realized as he ran his hands along the steering wheel in an attempt to calm himself with familiar tactile sensation. Dr. Novak’s pride, too. Cas’s pride. And Cas’s  _trust_. If Dean stayed and Cas was fired for any of the reasons relating to Dean… Dean shuddered.

It was the only thing he could do. He knew there would be paperwork to make it official, and that tossing his badge away probably hadn’t been the smartest thing to do -

He groaned. His locker. He couldn’t get into the locker room without his badge, but right this second he couldn’t imagine anything more humiliating – or that would dim the rather satisfying rage he’d worked himself into – than asking someone to let him into the locker room. That would turn a justified storming out of the building into something much closer to a walk of shame.

Slowly, he pulled his phone from his pocket.

_Can you clean out my locker for me and bring it to my place? Combo is 43-30-18._

It wasn’t long before Cas’s reply made his phone buzz, the sound loud in the silent car.

_Yes. Why?_

Dean grit his teeth.

_I quit this morning._

A full minute didn’t even pass before the buzz sounded in a new rhythm, and Dean stared down at the ringing phone with a sickly twist. This wasn’t a conversation he could have over the phone.

He jabbed his thumb at the red “ignore” button, the adrenaline from his temper and resulting stalk to his car beginning to go sour in his veins.

_Just come over_ , he typed, then shut his phone off completely. He didn’t want to see the voicemail icon or any responding texts. He didn’t want the story pried out of him while it was still so fresh.

He reached over and plucked the keys from the seat, and this time was much more successful in shoving them into the ignition. The eight dollars he had to pay at the exit to the parking garage due to his lack of employee badge made him bite his tongue so hard it nearly bled, and as he drove home, Dean wanted nothing more than to punch something, get drunk, and pass out.

He did none of these things. He wandered aimlessly around the house, his rage cooling and shrinking into something he shied away from when he remembered it, the edges sharp and raw.

He took another shower, a long, hot one, until the water ran lukewarm in warning.

He made himself a can of soup, left over from his bout with the plague earlier that month.

He settled himself onto the couch and stared at the TV, flipping through the channels and watching none of it, letting the colors and sounds wash over him and lull him into numbness.

IV

The knock at the door sounded again, and Dean knew that ignoring it was useless, especially when he’d requested the company to begin with. Switching off the TV, he sighed and pushed himself off the couch.

“Hey,” he said heavily as he opened the door, stepping aside and gesturing at Cas to come in.

“Hey.” Cas held out the bag he was holding. “Any particular reason you couldn’t clean out your locker yourself?”

Dean took the bag with one hand, digging the other into his pocket. “I, uh, kind of threw my badge at the HR person. Can’t get into the locker room without it.”

“Right.” Cas nodded slightly. “And that didn’t strike you as a bit overdramatic?”

Dean fidgeted. “Maybe a little. It seemed like a good idea at the time.” He let the bag drop to the floor. “Make yourself at home. Sam and Jess are gone until the second. We’ve got the place to ourselves.” He chuckled darkly. “Can’t say I’ll be very good company, though.”

Wandering into the kitchen with a vague idea of grabbing beers for them, Dean was surprised to see Cas following him. “Dean…why did you quit?”

Dean closed his eyes and turned slowly to face the surgeon. “They’re trying to fire you,” he said bluntly, and then wondered if maybe he shouldn’t have eased into it more gently.

But Cas did not look surprised; he merely nodded, regret casting a shadow over his eyes. “I know,” he said quietly, “or at least, I suspected, which is the other side of the same coin.”

“They tried to use me as an excuse.” Even now, hours later, it made anger bubble in the pit of his stomach. “Tried to make it out like you were ‘abusing your authority’ or extorting me or…” Dean shook his head. “Quitting like that probably didn’t do you any favors,” he admitted.

Cas shook his head. “If they’re determined to give me the axe, they’ll find a way eventually,” he replied. He leaned over to rest on his forearms on the counter. “I should probably accelerate my plans to leave before they get the chance.”

Dean froze in the act of taking down glasses from the cupboard. “Plans to leave?” he repeated.

Cas nodded. “I was going to keep it quiet until I came to a decision…and then after this weekend…” he cleared his throat. “I was going to discuss it with you. Because it seemed like something I should do.” He let his eyes fall to his hands clasped in front of him. “I’ve been unofficially offered a position on the University of Washington cardiovascular research team,” he said quietly. “They need a CVPV surgeon for the ten years they’ll be studying these intramuscular heart monitors. The head of the research team was one of my professors, and…he remembered me. Gave me a call.” Cas shifted. “It’ll be much less demanding than what I was doing before – lower pay, too, not much more than a typical research stipend, but…”

“It sounds like a good opportunity,” Dean said, keeping his voice neutral. “Especially given the bullshit going on here.”

“My thoughts exactly,” Cas replied, glancing up. “I was already leaning toward yes. I was going to call him when he got back into his office on the fourth. But then…”

“Then I screwed things up.” Dean sighed as he pushed a glass of water across the kitchen island toward Cas. “I have terrible timing.”

“I wouldn’t say you screwed things up,” Cas countered. “But…your timing could use work, yes.” Cas watched the water in his glass for a moment before taking a deep breath. “It would certainly put this conversation on more even footing if we’d been doing this for a little longer first.”

A tiny suspicion took root in Dean’s mind. “What do you mean?”

“What are you going to do now?” Cas asked abruptly, bringing the glass of water to his lips and looking expectantly at Dean.

Dean sighed explosively. “I don’t know. I’ve kind of well and truly burned my bridges with the medical group, and they’re practically the only name in town when it comes to surgery.” He let a little bitter smile quirk a corner of his mouth. “I thought about loading all my shit into my car and just…wandering around and seeing where I ended up. Like I used to do, when it was me and Dad. But…”

“But that’s not you anymore?” Cas interjected.

Dean snorted. “No. I have too much shit to fit into my car now.” He shrugged, leaning back against the refrigerator. “I never got used to having money to spend. I’ve got a decent chunk sitting around in the bank. I don’t have to figure things out right away, I guess.” He huffed a short laugh. “Hell, I could even look into nursing school, or PA school – assuming they’d want someone like me.” He glanced up. “Never was really serious about it before, with work and all, but now…”

“You’d make a good PA,” Cas said confidently. “Or scrub nurse. Or are you done scrubbing?”

“I don’t know,” Dean admitted. He looked down at his feet. “I like it. And it’s not like the lawsuit thing is going to follow me around like it will you. I could scrub anywhere, if I wanted.”

“What about Seattle?” Cas was very studiously peering at his water.

“What about it?” Dean replied.

“You ever been there?”

“Once or twice,” Dean said, noncommittally.

“Would you like to go back?”

“Cas.” Dean took a step forward and leaned over the kitchen island, looming until Cas looked up. “What exactly aren’t you asking me?”

A shy smile played at the corners of Cas’s mouth. “You’re a good tech, Dean. You already know what I’m asking for.” He licked his lips nervously. “You know what comes next.”


	20. Epilogue

**Notes for the Chapter:**

> Dean had rarely seen Sam cry.

He supposed Sam wasn’t technically crying now; he was blubbering a bit, but he wasn’t sobbing. That would probably have ruined the wedding pictures. Dean couldn’t say his eyes were entirely dry either as Jess made it down the aisle to where Sam stood, her own eyes gleaming with tears. In fact, there probably wasn’t a dry eye in the entire room.

As the ceremony got underway, Dean forced himself to pay attention to the rambling words of the officiant. This was a very important day in his brother’s life and, if the way Sam was looking at Jess was any indication, Sam wasn’t hearing any of it and might ask Dean for details later.

It was at least blessedly short, neither Sam nor Jess being particularly religious, and Dean did not have to resort to biting the inside of his cheek to keep himself awake until they triumphantly strode back up the aisle together as their gathered friends applauded.

Dean found Cas milling about in the foyer and waved as he took up his position near the front of the receiving line next to Jess’s younger sister. “Go get the car,” Dean mouthed as the rest of the wedding guests began spilling out of the hall, overflowing with hugs and handshakes and a lot more friendly touching that Dean wanted to escape as soon as it was humanly possible.

“Big turnout,” Cas commented blandly as Dean slid into the passenger seat of the rental car the better part of an hour later.

“Yeah, well. You know how the medical community is,” Dean said dismissively as they pulled away from the curb, pulling up the GPS on his phone to navigate toward the reception. “Everybody knows everybody. At least no one from Summit or St. Luke’s made a big deal about me being there.” He glanced to the side. “Or you.”

Cas snorted. “I wasn’t around here long enough to be part of the community, and once we left, the drama disappeared. That’s how it goes.”

“I guess so.” Dean’s phone announced the approach of their freeway entrance. “Take this one. Should be five minutes from here.”

Dean shifted, reaching up to tug at his bow tie and wishing he could undo it, but he doubted his ability to tie it again for the endless photography session he knew was coming. This car was too quiet to match the familiar scenery as it rolled by outside the windows; it should be accompanied by the dull roar of his engine and the vibration of his seat. That was how he’d always known this stretch of highway. This rental may have the same logo on its hood, but it was hardly an Impala.

“There’s food at the reception?” Cas asked as he twisted briefly in his seat to check his blind spot before changing lanes.

“Yup. Good stuff. I helped pick it out.” Dean cleared his throat. “Dancing, too.”

“Is that so?” Cas glanced to the side at Dean for a moment, face studiously straight.

“Not that either of us would be interested.”

“Of course not.”

There was, indeed, food that was already being passed around on trays, small bites intended to tide the guests over until the wedding party arrived and the full meal could be served. Dean was buttonholed almost before he could procure a skewer of teriyaki chicken and he handed it mournfully off to Cas as the Maid of Honor whisked him off to one of the side gardens for wedding portraits.

“All right, now the groom and the Best Man,” the photographer said, and everyone stepped to one side except Dean and Sam.

“How many more of these are you expecting?” Dean asked through his best smile. “My cheeks hurt and I’m starving.”

“I hope not too many more,” Sam replied as the camera flashed. “But I’m not in charge.”

Sam’s hopes were granted; after a few more terribly contrived group shots, they were all dismissed into the reception to a great deal of applause and cheering, no doubt, Dean suspected, because everyone knew the food would soon follow.

Some time later, as plates were cleared away, the unmarried women flocked to the dance floor for the ritual bouquet toss and the unmarried bachelors made a reluctant line to the side of the floor, knowing what fate awaited them. And it was no surprise that as the garter Sam flung at them sailed right over their heads, no one made any attempt to catch it, and in its momentum it clipped Cas on the side of the head halfway across the room.

“He didn’t  _catch_  it,” Dean insisted in a loud, good-natured response to the cheers of the guests as Cas bent to gingerly retrieve it from the ground and tossed it back toward the cluster on the dance floor. “It doesn’t count!”

The pageantry over, the dance floor cleared as the music switched to Sam and Jess’s first dance. As was quickly becoming their custom at any gathering, Dean and Cas hung to the side of the crowd, preferring to watch others enjoy themselves and retain their private corner away from the eyes and prying questions of other people.

“You know,” Cas said thoughtfully as his eyes followed Sam and Jess on the dance floor, “I never thought I’d find myself wanting a wedding.”

Dean had to stop himself from choking. “A wedding?” he asked, somewhat weakly. “With, like…tuxes and vows and blinky lights and everything?”

“Maybe not the blinky lights.” Cas glanced to the side. “But…”

Dean swallowed. “I…can’t even think about that kind of stuff until all this trial shit is cleared up,” he said seriously. “If they’re going to decide she’s guilty and then try to charge us with accessory to murder, that would kind of throw a wrench in picking out china patterns.”

Cas grinned, only slightly crestfallen. “You make a good point.”

“But after.” Dean returned his gaze to the dance floor as the song finished and Sam and Jess kissed. “After…we can talk about it.”

“After,” Cas agreed, reaching out to twine his fingers around Dean’s.

“And after I finish nursing school,” Dean added quickly.

“Right.” Cas gave Dean’s hand a squeeze.

“And pie instead of cake.”

“And…what?” Cas turned his head to look questioningly at Dean.

“Just a thought.” Dean grinned and brought his champagne flute up to his lips. His mind wandered to the corner of his sock drawer, where a small nondescript box contained a simple brushed titanium ring. It waited patiently for the right time, when Dean would take it out and put it in his pocket.

Because Dean knew exactly what his surgeon wanted, and would be ready when he needed it.


	21. Appendices

##  _Appendix I: Surgical Procedures_

**AAA:**  Abdominal Aortic Aneurysm. The aorta, the large blood vessel leading from the heart, develops a bulge (aneurysm) that weakens the walls. The aorta’s walls can then dissect themselves, leading to heavy internal bleeding and death. The AAA procedure requires making an incision in the midline of the body and dissecting down to the aorta and the location of the aneurysm, then implanting a graft to strengthen the aortic walls. With modern imaging a AAA can often be diagnosed long before it becomes emergency, but on occasion an aneurysm can dissect acutely and require emergency surgery.

**Vein Stripping** : The patient presents with varicose veins, veins that run close to the surface of the skin on the legs and are painful. These veins can occasionally lead to higher chance of blood clots, and so to reduce the pain and reduce the chances of a clot, the patient may undergo vein stripping. In this procedure, the most common stripped vein is the greater saphenous vein. An incision is made in the crease of the leg near the groin, and the saphenous vein is cut and tied off where it joins with the other greater veins of the lower body. The surgeon then makes several smaller incisions along the path of the vein and uses a curved hook, much like a crochet hook, to reach beneath the skin and pull up a portion of the vein. The vein is removed either in small pieces or one large piece, depending on the strength of the vein walls, diameter of the vein, and patience of the surgeon.

**Arteriovenous fistula creation/repair/shunt graft** : A fistula is a created hole connecting two structures. In this case, the patient must undergo dialysis, and continual access to the veins for dialysis without intervention will cause vein collapse. This procedure creates a fistule between an artery and a vein that strengthens the vein. An incision is made in the lower arm and the surgeon selects an artery (blood flowing from the heart) and a vein (blood flowing to the heart) and cuts them, then sews them together end-to-end. Over time, this strengthens the vein sufficiently to allow access for dialysis without danger of vein collapse. In some cases, the surgeon may elect to use a graft (artificial implant) to strengthen the vein walls; in this case the graft is a shunt, often a tubular length of Goretex, that is slid inside the vein before the surgeon sews the vein and artery together. In a repair, the fistula is not healing correctly, and the surgeon must either reconnect the ends or select a different vein and artery to connect.

**BKA** : below-knee amputation. Catastrophic infection or bone death that will lead to infection necessitates the removal of the leg below the knee. A tourniquet is placed on the upper leg to control bleeding and a surgeon very carefully dislocates the knee and cuts away the tissue, removing the lower leg. She will leave a skin flap to close over the stump of the leg after she reconnects vital blood vessels. This procedure is often performed by an orthopedic surgeon, but shewill likely partner with a vascular surgeon to reconnect the larger blood vessels.

**Extracorporeal Shockwave Lithotripsy** : or  **ESWL**  (ez-wall). The patient presents with kidney stones that are too large to remove through normal ureteroscopy. A large C-shaped machine that can move freely around the bed is placed. This machine will deliver concentrated ultrasound waves to a pinpointed area where the stone sits. This ultrasound will crush the stone into smaller pieces that the patient can pass on their own or the surgeon can remove. An ESWL is performed by a radiology technologist or radiologist under the direction of a surgeon. In this type of surgery there are no incisions or entrances into the body.

**Transurethral Resection of the Prostate:**  or  **TURP.**  The patient presents with an enlarged prostate gland. The surgeon, through a cystoscope, whittles chips of the prostate from inside the urethra to enlarge the urethral opening and relieve the discomfort of the enlarged prostate gland.

**Cystoscopy/Ureteroscopy** : the use of a scope to visualize the bladder or ureters. The scope - a long lens apparatus attached to a camera, which broadcasts to a video screen - is inserted into the patient’s urethra and manipulated into the bladder. Occasionally, thing flexible wires are fed through access ports in the scope to allow for easier navigation and use of instruments for cauterizing, biopsying, or stone crushing via laser.

**Laparoscopic Cholecystectomy:**  or  **Lap Chole**. The patient’s gall bladder must be removed. The surgeon makes four small incisions in the patient’s abdomen and places ports in the incisions to access the abdominal cavity. Using long-handled instruments and a scope for visualization, the gall bladder’s arteries and veins are clamped, the gall bladder is dissected away from the liver, and it is removed through one of the ports.

 

* * *

 

##  _Appendix II: Surgical Specialties_

**Vascular/Cardiovascular/CVPV:**  A vascular surgeon specializes in surgery of the blood vessels and the heart. A cardiovascular surgeon focuses more specifically on the heart itself and the vessels connected directly to it. A peripheral vascular surgeon focuses primarily on the vessels throughout the rest of the body. A CVPV (cardiovascular and peripheral vascular) surgeon will perform surgeries pertaining to both these regions.

**Urology:**  A urological surgeon specializes in surgeries of the urinary system, including the kidneys, ureter, bladder, prostate, and urethra. Because of the structures involved, often a urologist will treat abnormalities of male genitalia, including the testes, as well. Urological surgery is most often achieved through the use of scopes inserted into the urethra, with long, slender instruments then inserted into the access port of the scope to perform the procedure.

**Gynecology:**  A gynecological surgeon specializes in surgeries of female genitalia, uterus, Fallopian tubes, and ovaries. A surgeon who performs procedures directly linked to pregnancies is an obstetric surgeon, whereas a surgeon who focuses on all other aspects of the female reproductive system are gynecological surgeons. Often a surgeon will specialize in both, and are called  **OB/GYN**  (oh-bee-guy-nee) surgeons.

**Plastics:**  a plastic surgeon performs reconstructive procedures for aesthetic results. While much of plastic surgery is to enhance or change physical appearance, many plastic surgeons perform aesthetic surgery to lessen the appearance of a previous surgery, or to enhance the patient’s life. For example, a plastic surgeon may perform a breast reconstruction after a mastectomy which removes the patient’s breasts due to cancer, or a surgeon may perform a blepharoplasty to remove excess eyelid that is reducing a patient’s vision. Plastic surgeons must be very mindful of the natural tension of the skin and how the fat under the skin will effect appearance. They will often perform procedures in which a cancerous lesion must be removed from the face.

**ENT:**  Ear, Nose, and Throat. What it says on the tin. Tonsillectomies are the meat and potatoes, though they also perform various sinus surgeries. Ear surgeries, like the installation of cochlear implants or drainage tubes, tend to be a specific focus.

**Orthopedics** : An orthopod performs surgery pertaining to joints and bones. Scopes are often used within joints, to avoid draining the joint of the lubricating fluid it produces. Broken bones are fixed in orthopedics, as well as joints replaced and extremities removed when it is deemed necessary. Orthopods will often specialize further and become hand, foot, shoulder, hip, or knee surgeons.

**Ophthalmics:**  An ophthalmic surgeon performs surgery on eyes. Most common are cataract surgeries, in which a cloudy or opaque lens is removed from the eye and replaced with a clear implant, restoring vision. Other ophthalmic specialists may concentrate on correcting eyes that do not focus together by lengthening or shortening the muscles that control the eye.

**Neurology:**  A neurosurgeon specializes in the brain, spinal cord, or peripheral nerves. While all surgery is precise, neurosurgery leaves very little room for error, as a single millimeter too far may kill the patient or render them paralyzed. This is a specialty for steady hands.

**General:**  a general surgeon typically catches any procedure that does not belong to a particular specialty. They often deal with organs or organ systems as a whole, removing gall bladders and appendixes, repairing hernias, removing cancerous tissue - there is a lot of removing things in general surgery. A general surgeon may specialize in a particular organ or organ system, opting to focus on stomach surgeries, intestinal surgeries, thyroid surgeries, etc.

 

* * *

 

##  _Appendix III: The Surgical Team_

**Surgeon:**  The MD performing the surgery. This doctor will have spent four years in medical school, often another four in a residency, and may have spent additional years in a fellowship to specialize. Depending on the complexity and scope of the procedure, more than one surgeon may be present.

**Anesthesiologist or CRNA:**  An anesthesiologist is an MD. They will have spent four years in medical school and another four in a residency. A CRNA is a Certified Registered Nurse Anesthetist. They will perform with the supervision of an anesthesiologist, and will have attended nursing school along with an additional two years of anesthesiology specialization.

**Circulating Nurse:**  A Registered Nurse, or RN, who is responsible for documentation during the surgery as well as ensuring that the room runs smoothly. This can include running to get supplies or instruments the surgical technologist forgot or didn’t know they needed, but this makes the circulator grumpy. Though patient safety is the responsibility of the entire surgical team, the circulator leads the team in this regard. The RN will have completed nursing school and may have completed additional specializations.

**Surgical Technologist:**  The team member responsible for ensuring all supplies required for the procedure are present, opening said supplies in manner that keeps them sterile, and arranges all supplies and instruments to be easily accessible during the surgery. During the procedure, the surg tech will act as the assistant to the surgeon, passing instruments and being an extra pair of hands when required. The surg tech must know the steps for every procedure as well as the surgeon to anticipate the surgeon’s needs. The surg tech will have completed a certificate program at a technical college or may have received training in the military.

_You may also see…_

**Physician’s Assistant:**  Occasionally a surgeon will need an assistant that has a wider scope of practice than a surg tech (eg, will need to be qualified to manipulate tissues, suture, inject anesthetic, etc). A PA has completed graduate school training of some duration and may be a full MD.

**Radiology Technologist:**  This team member is responsible for the C-arm, which is the X-ray machine that curves over the top and underneath the surgical bed. They are also responsible for the ESWL machine. This team member performs diagnostic or visualization X-ray during the procedure, allowing the surgeon to see if a bone has been aligned properly or if a kidney stone has been crushed successfully.

**Anesthesia Technician** : May have a wide scope of duties that vary by state and hospital. Often assists the anesthesiologist or CRNA in their duties.

**Vendor:**  Not a member of the hospital staff, these people are employees of a company that sells equipment and instrumentation to the hospital. They are present as expert consultants on the instruments or equipment in question. They are invaluable when using instrumentation such as plates and screws for fracture repairs, as these sets have hundreds of pieces and require expert knowledge to use properly. They may also operate equipment themselves, as is the case in many laser surgeries where the laser equipment is leased from the company.

**Med Student** : They will inevitably end up holding retractors or suctioning cautery smoke, or any other dirty/tiring/boring job the surgeon, surg tech, or PA doesn’t want to do. Hey, they’re an extra pair of scrubbed hands.

**Resident:**  Will often fill the PA role.

**Surgical Assistant:**  Will run to get supplies, help get the patient into and out of the room, and assist in cleaning the room between cases.

**Charge Nurse:**  the RN who is essentially the air traffic controller for all the surgical suites. He or she coordinates scheduling, ensures that the surgeons will be available for certain time slots, orders the supply carts, assigns teams to rooms, and a thousand other things that make the OR floor run smoothly. The charge nurse is God.

**Management:**  Nobody knows what Management does. They stand there, in their masks and hats, and say nothing. When you look up again, they have vanished back to their offices, as though they were never there.


	22. Glossary

**TERMINOLOGY**

_ABG_ : Arterial Blood Gas. A blood test that determines the percentages of oxygen, carbon dioxide, and the like in blood.

 _Anastomosis:_  the act of reconnecting two severed tubular structures (nerves, vessels, etc) in which care must be taken to reconnect them in the correct orientation.

 _Aseptic technique:_   Also known as sterile technique. A set of learned behaviors that maintain the sterility of the surgical field. Never touching the face or lap, never touching anything unsterile while you are sterile, and opening sterile supplies in a certain way are all aspects of aseptic technique.

 _autoclave:_  also known as flash sterilizer. A pressurized chamber that creates requisite pressurized steam of a temperature that kills all microorganisms on contaminated surgical instruments. Used in emergencies or when there is no time to wait for the full 8-hour sterilization process of Central Sterile Processing.

 _Biological:_  a daily test run on sterilizers throughout the hospital to ensure that they are killing spores. It is a package that contains a vial of spores. Once exposed to the minimum standard for sterilization, it is allowed to incubate for 2, 4, or 8 hours. If the incubation produces no growth, that sterilizer has passed its biological. Biologicals are also run with any load that contains implants, like screws or plates, and if the biological is not passed, a recall is issued for every instrument that used that autoclave since the last passed test. If those instruments were used, hospital policy may require alerting the patient and putting that patient on prophylactic antibiotics.

 _Central Sterile Processing:_  the hospital department responsible for the sterilization and assembly of surgical instruments and other sterile supplies. This department decontaminates, cleans, disinfects, assembles, then sterilizes all used instruments. This process is called “turning over.” CSP is a vital part of surgical services, and one that is often overlooked.

 _CHG:_  Chlorhexadine gluconate. Many hospital scrub solutions are made with this, as it is a very potent antiseptic safe for skin. Dries you out like a motherfucker, and the version that you don’t rinse off is all tacky and gross and squishy inside your gloves even when you let it dry. I have feelings about CHG.

 _Closing:_  the act of closing a wound. Often done in several layers, depending on which anatomical layers have been incised. Can be done with suture, staples, or glue.

 _Counts:_  a surgical technologist and circulating nurse must count sponges, needles, hypodermics, blades, and sometimes small instruments before the procedure begins and when it is over, as well as whenever the surgeon closes a layer, to ensure that nothing is left behind in the patient.

 _Decontamination:_  removal of visible debris from an instrument or surface. It looks clean, but you wouldn’t want to eat off it.

 _Disinfected:_  also known as “surgically clean,” this state is used to refer to a surface that has been washed thoroughly with a disinfectant like iodine, CHG, or other antimicrobial. It is not sterile, but is safe for use in non-sterile areas like the mouth or rectum. Examples include non-sterile gloves, blades used to insert breathing tubes, and speculums.

 _Electrocautery:_  the use of electricity to cauterize or coagulate flesh. Most often used in hemostasis, but also occasionally used to incise without causing bleeding.

 _Hemostasis:_  the act of controlling bleeding in the surgical patient.

 _Indicator:_  Often a color-changing strip of paper or tape indicating that the package it is on or in has been subjected to sterilization. The color only changes if the package has been exposed to proper temperature and pressure for sterilization. A changed indicator ONLY indicates that the package has been subjected, NOT that the contents are sterile (for example: if the instruments were not properly decontaminated, and a bone chip remained in a ronguer, nothing in that set should be considered sterile, even if the indicator says the package was sterilized).

 _Iodine:_  Often used in surgical scrub and prep solutions, as it is an excellent antiseptic. Kind of an icky yellow color.

 _Scrub:_  Used in several different ways. Refers to the action of “scrubbing in,” which is a two- to five-minute thorough hand wash with an antiseptic soap and scrub brush, using aseptic technique, in preparation for donning a surgical gown and gloves. Refers to the person who has scrubbed in to assist the surgeon (”scrub tech”). Refers to the surgical attire of the scrub top and scrub bottoms, which are often reversible cotton garments that are able to be cleaned at very high temperatures and are comfy as hell. I’m wearing scrubs RIGHT NOW, that I went out and purchased for my very own to be lazy in.

 _Sharp:_  any instrument that can penetrate gloves, skin, or drapes. Examples: knife blades, hypodermic or suture needles, skin hooks.

 _Spore:_  a dormant phase of a microorganism that is extremely difficult to kill, but can reactivate and cause infection once it is in a favorable environment. An item is not considered sterile until all spores are killed.

 _Sterile:_  this instrument harbors absolutely no living microorganisms, including spores.

 _Suture:_  stitches, or more precisely, the material used to create stitches. Comes in many different sizes and types, with many different needles.

 _Ties:_  Suture without a needle. Surgeon will use ties to tie off blood vessels for hemostasis.

 _Tools:_  We don’t use tools. We use instruments. Don’t call them tools. Please.

**INSTRUMENTS**

_Hemostat:_  a clamp used to occlude a blood vessel for hemostasis. May also be called a “snap,” depending on which coast the doctor trained. Kellys, criles, mosquitos, and schnidts are all hemostats.

_Retractor_ : holds the edges of a surgical wound open so that the surgeon can see what s/he is doing. These can be self-retaining, holding the wound edges by tension within the instrument, or hand-held, requiring an assistant to hold the instrument.

_Ronguer:_  Plier-like instrument that snips away at bone or cartilage.

_Speculum_ : That thing that looks like a duck that the doctor uses to expose your cervix (if you have one). Can also be used to open your rectum,  _gentlemen_. I mean, ladies have a rectum too, and a speculum can be used in lady bums as well as gentlemen bums, but gentlemen have fewer places where one can be used. Let's move right along, shall we?

_Vein hook_ : also known as muller hooks. A curved, crochet-hook like instrument that a surgeon can insert into an incision and twist to bring a vein up to the surface for vein stripping procedures.

_Weitlaner_ : The unofficial mascot of this story, the weitlaner is a self-retaining retractor that can be sharp or blunt, have varying numbers of teeth, and come in multiple sizes.

**SPONGES**

I am giving sponges their own category. Sponges are used to absorb blood to keep the surgical site visible. Sponges used during surgery will always have an x-ray detectable strip embedded in them, so that they can be seen on x-ray if they are left in the patient. Some sponges now contain RFID strips, so that x-ray becomes unnecessary, but that’s a bit fancy for the likes of Summit Surgical Center.

_Kittner_ : also known as peanuts or cherries, although those names can also refer to different sizes or shapes of small sponges like this. These are often clamped on the end of a hemostat and used for blunt dissection (pushing tissues apart rather than cutting them).

_Laparotomy_ : or just lap. You’ll see these more often in surgeries with lots of bleeding or larger incisions, like abdominal or thoracic surgery. Very absorbent and very soft. If a surgical package contains laps and the tech knows they won’t be used, they will often pass them off the field so they don’t need to be counted. And then, since they were not present during the surgery, the nurse, scrub, surgeon, and anyone else around will often argue over who gets to take the laps home instead of throwing them away. Because laps are awesome and you want to have them around at home. (I have 60.)

_Raytec_ : Most commonly used sponge, also called a 4x4. Incredibly absorbent, can be unfolded and folded again into different shapes and widths, and very easy to lose inside a patient, thus those blue x-ray strips. Raytecs are often the first items counted when counts are done, since they are so easy to lose.


End file.
